SSEP Order Document

	Dealer Equipment Service 5775 Enterprise Drive Warren, MI 48092-3463	FAX: (866)-466-9213 Phone: (888)-458-4040

DEALERSHIP CODE: null	DATE: 05/19/2012
DEALERSHIP CONTACT: null

SOLD TO:
Customer:

Attn.:

Street:

City:

State:	Zip/Postal:

Tel. No.:

Fax No.:

E-Mail:


SHIP TO:
Customer:

Attn.:

Street:

City:

State:	Zip/Postal:

Tel. No.:

Fax No.:

E-Mail:

PAYMENT PLAN :
	DEFERRED BILLING (30/60/90) __________ Add 2% Service Charge-Minimum $5000 transaction
	DES OPEN ACCOUNT (Net 30 days, requires DES approval
	2%PREPAYMENT DISCOUNT (Check enclosed)
	VISA American Express		MasterCard Discover
	ACCT#::_________		EXP::_________
	Name on card::_________________________
	LEASE TERM DESIRED (month) _________ Name of Lease Company _________________ Contact:_________ Phone:_____________
IF NO TERMS ARE CHECKED; BILLING WILL DEFAULT TO 30 DAY OPEN ACCOUNT DEALER BILLING
	DO NOT SHIP UNTIL NOTIFIED Estimated Ship Date:___________________
	NEW FACILITY ORDER Plan Sales Order Number:_______________
	READY TO SHIP
SALES ORDER NUMBER:___________________
ORDER/QUOTE EXPIRATION DATE :__________

AUTOHAUS BLUE RAL 5003

OTHER ________

110V

220V

SINGLE PHASE

3 PHASE

(MBUSA MUST APPROVE ANY OTHER COLOR CHOICE FOR Lifts, Alignment, Tool Chests, Work Benches, Tire Changer and Wheel Balancers)

QTY.	Part Number	Description	Unit Price	AMOUNT


Sub Total				0.00
Estimated Freight*
Estimated Installation
Taxes
Total


Authorized Dealer Signature	Date:
____________________________________________
Authorized Dealer (Print name) Signature	Date:
____________________________________________
ALL SALES ARE FOR SHIPPING POINT. By signing above Dealer accepts all terms and conditions of sale, which are contained within the Program catalog
INSTALLATION: Does not include Electrical or Air (Dealer's Responsibility) * I agree that the freight is estimated and my lease/bill will reflect the actual freight charged for all shipments.

Initials _______________________