This form can be used if you prefer to fax or mail in your order form. Enter your item number(s) in the space below and the Web site will fill in the description and current price(s). Then, calculate the Shipping and Handling costs (and taxes if applicable) manually using the table(s) provided. Provide the remaining billing, shipping and payment information needed to complete the order then fax or mail the form to PAR (see below for fax or mailing information). Caution, once you print and close the form you will not be able to retrieve the item information. If you need to include more items, write them in the Additional Items section, and update the order subtotal.
Enter your item numbers below, and the Quick Order Form will generate the item description and the price.
Note: Item numbers consist of 4 digits plus a 2-letter suffix (e.g., 2237-TB).
Click here to print this form, then complete the rest by hand.
(Please see the bottom of this form for fax or mailing information.)
This area is for you to hand-enter additional items and prices after you have printed your Quick Order Form.
Subtotal 1
$
Florida residents, add applicable sales tax. Michigan residents, add 6% sales tax.
(Enter rate from box at left.) U.S. Ground Service (required on all U.S. orders)
Note: $8 minimum S&H charge.
PLUS expedited U.S. service charge:
(Enter desired shipping method
_________________
and $ amount for expedited service from box at left.)
Enter Promotional Code from special mailing (if applicable) and calculate.
□ New Customer | □ Address correction | □ Register for online ordering (e-mail provided below)
Customer no. ______________________________ Date ___________________
Company/Institution _______________________________________________
Name _____________________________________________________________
□ Dr. | □ Mr. | □ Ms. | □ Mrs.
Address ___________________________________________________________
□ Home | □ Office
City _________________________ State/Province _______________________
Zip/Postal code ________________ Country ____________________________
Phone (______)_____________________ Fax (______)_____________________
E-mail address*_____________________________________________________
□ Residence | □ Business
Street Address ____________________________________________________ (No P.O. Boxes)
*Tracking information will be provided via e-mail for U.S.A., Canada, and expedited international orders.
□ Charge:
□ MasterCard® | □ American Express | □ Diner's Club International | □ Visa® | □ Discover
Card # (do not include hyphens) |___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|
Exp. date |___|___||___|___| CVV (3- or 4-digit number found on your credit card) |___|___|___|___|
Name on card (if different than Customer)_____________________________________________________
□ Check enclosed payable to PAR, Inc.
□ Purchase Order enclosed (For Customers from the U.S.A., Canada, Puerto Rico, and the U.S. Virgin Islands only)
□ I accept responsibility for all shipping, handling, duty, and VAT charges for this order.
Authorized signature (Required on all orders) _____________________________________________________
This quote is valid for 60 days. Prices are subject to change without notice. Please call (1.800.331.8378 • 1.813.449.4065) for current pricing. Florida and Michigan residents, please include applicable sales tax.
Order Form may be submitted via fax (1.800.727.9329 or 1.813.961.2196), or mail (PAR, Inc., 16204 N. Florida Ave., Lutz, FL 33549-8119).
Orders placed Monday–Friday by 6 p.m. EST will ship the same day (except holidays).
All other orders will ship the next business day. You will be notified of any unexpected delay.