Dalton Manufacturing September 2023 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: (____) _____________________________________

Hydraulic

Cylinders

Rod &

Tubing

PAYMENTS

Hydraulic Pumps

!

!

COD !

Existing Account

S HIPPING O PTIONS

Check/Money Order

Common Carrier: ! Economy

UPS:

! Ground ! Next Day ! Next Day - Sat

!

!

!

Visa

MasterCard

AmEx

! Other (please specify) _____________________ _____________________ _____________________

Hydraulic Motors

Card #: _________________________Expires: ____/____ Signature: _______________________________________

! 2Day ! 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