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Order Form - BATTERY
Credit Application - Online
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Instructions - Online Forms
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Online Battery Order Form - All orders are confirmed via telephone. Information boxes marked with an asterisk (*) require an answer.
Purchase Order#:
Date Needed:
Battery Model or Part#: *
Forklift Make / Model: *
Plug Color: *
Quoted Price: *
Taxable?: * Yes No
Tax Exemption# (if applicable):
Would you like to set up a N30 account? If so, please fax credit references to: 646-519-4723, Attn: Credit Dept.: Yes No
BILLING - Company Name: *
BILLING - Complete Address: *
BILLING - Contact Name: *
E-Mail Address: *
BILLING - Phone#: *
Is the shipping information the same as the billing information? If not, please add the desired shipping information below: * Yes No
SHIPPING - Company Name:
SHIPPING - Full Address:
SHIPPING - Contact Name:
SHIPPING - Phone#:
CREDIT CARD INFORMATION - If you would like to make this purchase using a credit card, please enter the type of card (Visa, MaterCard, Amex):
Expiration Date:
Authorization Code:
Card Holder: