"Sales Order #"
Electronix Express / RSR Electronics, Inc. 900 Hart Street, Rahway, NJ 07065 1-800-972-2225 (In NJ: 1-732-381-8020) URL: http://www.elexp.com (email: firstname.lastname@example.org) Customer Number Date BILL TO / SHIP TO: (IF SAME LOCATION) SHIP TO: Sales Order # Name Name Department Department Company/School Company/School Address Address City/State/Zip City/State/Zip Phone Number Phone Number FAX Number METHOD OF PAYMENT Purchase Order No. (Net 30) Ship Via Visa Mastercard American Express C.O.D. – Company Check Money Order Certified Check Upon Credit Approval Please do not send your Credit Card Information via email. Be sure to include your daytime phone number so that our Internet Response Team can call you to obtain your credit card information. You can also FAX us your credit card number or mail it to us. Qty Part No Description of Item Cost Ea. Ext. Price Sub Total 7% NJ Sales Tax (NJ Residents Only) Shipping TOTAL OF ORDER Comments: 1