| Tri-Dee Distributors Inc. |
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FLAT FILE DELIVERY INSTRUCTIONS
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2nd order form feedback form |
| Your Name or Company : Name: Company: |
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| Your Card Billing
Address: Address Line 1 Address Line 2 City:State: Zip Code: |
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| Phone Numbers: Contact: Cell: Fax: |
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| PO # (if required): | |
| Email: | |
| Shipping Address (if
Different): Name: Address: City: State: Zip Code: |
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| Part Number | Description of Items Ordered | Quantity | Price | Extended |
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| Cutting Charge | ||||
| Freight Charge | ||||
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Total |
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Special Instructions
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Card Number:
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Expiration |
Card Type: Debit
Amex,
MC, |
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Card Verification Value: This number is not embossed. Amex 4 digits on front of card, for all other cards it is 3 digits normally on the signature strip on the back. |
| Revised 9/28/03 |