Idacom Telephone Repair Packing List

Date: __________________________ Purchase Order #: _______________________________

Company Name: ________________________________________________________________

Billing Address: ________________________________________________________________
Street Address City State Zip Code

Shipping Address: _______________________________________________________________
Street Address City State Zip Code

Contact Person (Please Print):_____________________________________________________

Company Phone Number : ________________________ Fax: ___________________________

E-mail Address: ________________________________________________________________

Telephone Manufacturer(s)/Model(s) and Repairs Needed for Each:

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

TOTAL UNITS SENT _________ (Print additional copies of this form if you need more space!)

Payment: COD ____ NET 15___ NET 30___ (PRIOR APPROVAL REQUIRED!)

Credit Card: MC___VISA___DISCOVER___ AMEX ___

We will call for the credit card number prior to shipment.

Return Shipment Instructions:

Ground ______ 3 Day ______ 2 Day ______ Next Day ______

Signature: ___________________________________________