Dalton Manufacturing May 2024 Edition

Order Form

B ILLING A DDRESS Company Name: _________________________________ Contact Name: __________________________________ Mailing Address: _________________________________ City: __________________________________________ State/Province: __________________________________ ZIP/Postal Code:____________ Country: ____________ Telephone: (_____) ______________________________ Fax: (____) _____________________________________ Email: _________________________________________ Purchase Order #:________________________________ Tax Exempt #: ___________________________________ __________________ ____________________________

S HIPPING A DDRESS Company Name: _________________________________ Contact Name: __________________________________ Mailing Address: _________________________________ City: __________________________________________ State/Province: __________________________________ ZIP/Postal Code:____________ Country: ____________ Telephone: (_____) ______________________________ Fax: (____) _____________________________________

Cylinders

Hydraulic

Rod &

Tubing

PAYMENTS

Hydraulic Pumps

q

q

COD q

Existing Account

S HIPPING O PTIONS

Check/Money Order

Common Carrier: q Economy

UPS:

q Ground q Next Day q Next Day - Sat

q

q

q

Visa

MasterCard

AmEx

q Other (please specify) _____________________ _____________________ _____________________

Hydraulic Motors

Card #: _________________________Expires: ____/____ Signature: _______________________________________

q 2Day q 3Day

O RDER I NFORMATION

Page:

Price:

Qty:

Part #:

Total:

Hydraulic Valves

Description:

Units

Power

& Accessories

SubTotal: Shipping Charges: Sales Tax: Tota l:

Hoses, Fittings

Transmission Bearings

Service Charge for Unpaid Items DBH reserves to right to assess a 2% service charge on charges left unpaid over 45 days.

Power

124

Miscellaneous