Rudolph Information Systems Home Page

E-MAIL
ORDER FORM

To place an order via E-MAIL, please fill in the information below and click on the button at the bottom of the form. Please print out the the confirmation page for your records before closing your browser window, or use the button at the bottom to print this page for your records.

SOLD TO
Name
P O Box
Address
City
State		Zip
Phone
E-Mail

SHIP TO
Name
Address
City
State		Zip
Phone

Customer Order #:

Salesman:

Cash

Charge

C.O.D.

Credit

F.O.B:

Terms:

Date:

ITEM	Quantity	Description	Price	Amount
1
2
3
4
5
6
7
8
9
10
Mdse. Retd:		Paid Out: Received by:	TOTAL $

This slip must accompany all claims and returned goods

The space below is provided for you to ask additional questions, or for special instructions regarding your order.

Before submitting this form, please print a copy for your records