Quick Quote Order Form

(*Note: The character limit to each of the following fields is 29. If the information exceeds 29, please check with the shop for acceptable abbreviations)

Vendor Name:_______________________________ Phone:(_____)__________________

Shop Name (End User):______________________________________________________

Shop Address:_____________________________________________________________

Shop City:________________________________________________________________

Shop State:________________ Shop Zip Code:__________________________________

Shop Phone (______) ____________________________

Shop Fax (______) ______________________________

Shop License Number (if state required) _______________________________________

Disk Size: 3.5" High Density _________ 5.25" High Density ___________

1. Payment Instruction: (circle one)

A. (CC# on file)

B. CC# _________________________________ Type: ___________ Exp: ______/______

C. C.O.D. (add $6.00 to shipping charges)

D. Payment enclosed, check # _____________

2.Shipping method, includes handling charge: (circle one)

UPS Ground $9.00 ...............................................................2nd Day Air Service $14.00

Next Day Air Service $24.00.............................................Next Day Air Saturday $34.00

4. Shipping/Handling/COD Charges must be added to your invoice accordingly. An additional $6.00 handling charge will be incurred on vendor errors requiring reshipment.

5. Price Sheet Amount _____________ + S/H/COD ______________ = Total ____________

Send to: Quick Quote, 18975 Mesa Drive, Villa Park, CA 92861 or Fax (714) 283-8537