4apc.com - Order Form

All products come with full manufacturer's warranty. Manufacturer's warranties vary among products lines; please inquire when placing your order.

Michigan residents are subject to 6% sales tax.

Items Ordered:

Quan Part # Description Unit cost
1.
2.
3.

Shipping Address:

To whom should this order be sent?

Name and/or department   
Street Address   
Street Address   
City or Town     State     ZIP   
Phone No.     Ext.   

Billing Address:

To whom should this order be billed? (Fill out only if different from shipping address.)

Name of payer, department
Street Address   
Street Address   
City or Town     State     ZIP   
Phone No.     Ext.   

Payment Method:

Select from one of the following:   

Check no., PO no., or other detail:   

Special information:   

Shipping Method:

Select from one of the following:   

Contact Info:

In order that we may inform you when your order has been processed, please tell us your:

email Address:   

Daytime Phone:      Ext.:   


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Mail to our sales department


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