®
19
CLASSIC 1000
REMOTE COOLER
®
Part Number
Part Description
Qty Required
Price per Unit
Cost
OFFICE USE ONLY
Total Cost
Delivery
VAT @ 17.5%
Total Order Value
IMI Cornelius standard terms & conditions of sale apply.
2.
3.
Please complete fully all parts 1-4
Name:
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Company Name:
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Day Time Phone Number:
----------------------------------------
Fax Number:
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Invoice Address:
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Delivery Address:
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----------------------------------------------------------------------- -----------------------------------------------------------------------
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Post Code:
----------------- ----------------------------------------
Post Code:
-----------------
Special Instructions:
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OFFICE USE ONLY
Cornelius Account No.Customer Order Number:1.
ORDER FORM/
PROFORMA INVOICE
Please indicate payment method: Account Cheque Postal Order Access/Visa
Cheques or Postal Orders should be made payable to IMI Cornelius (UK) Ltd.
For Access or Visa Payments, please indicate your card number.
Expiry Date:
---------------------------
Signature:
------------------------------------------------
Name:
--------------------------------------------------
Date:
--------------------
Address:
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Post Code:
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4.
☎
ORDER
8.30 am
HOTLINE
5.15 pm
TEL: 0114 285 5886 FAX: 0114 232 1070
Please return to: IMI CORNELIUS (UK) LTD Rawson Spring Way Riverdale Industrial Estate Sheffield S6 1PG
OFFICE USE ONLY
Acknowledgement No. Cheque Clearance Date Due Date Request Date
(16 pages)
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