World Wide Electric, Inc 2235 E. Francis St Ontario, Ca 91761 Phone-866.427-3946 Fax-909-230-4829

Ship To:

Bill To:

Vendor: World Wide Electric, Inc.

PO #

PO # Date:

Account Number:

Service Center Name:

Authorized Signature:

Contact Person:

Payment Type (Circle One)

Credit Card

COD

Open Acct

Prepaid

Phone Number:

Fax Number:

Credit Card #

Part#

Model#

Description

QTY

Unit Price

Extended

Price

Total

IMPORTANT:

TO RECEIVE PROMPT PROCESSING, PLEASE FOLLOW THE INSTRUCTIONS BELOW

1. This form is to be used for parts orders only. Service Manual requests are to be emailed to

[e-mail]

.

2. Please type or print clearly.

3. Refer to the Service Manual for part umbers and descriptions.

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4. Incomplete forms will be rejected.