Existing Customer Order Form

Request for Information: Please complete the following form and click Submit. We will contact you as soon as possible regarding your request.

Person Requesting *

Company Name *

E-mail Address *

Telephone Number or Nextel Number

Community/Project Site Name

City

State

Zip Code

Purchase Order Number (if required for payment)

Job Number (if required for payment)

Quantity		Product		Delivery Address		Delivery Date

Quantity		Product		Delivery Address		Delivery Date

Quantity		Product		Delivery Address		Delivery Date

Quantity		Product		Delivery Address		Delivery Date

Quantity		Product		Delivery Address		Delivery Date

Please enter the street number and lot number with street name. When a delivery is entered as a lot number and the subsequent pick up order is entered as a street number and name we will not know which unit to take off invoicing.

Delivery directions from the nearest main road. (Start with the direction of travel such as, South on Hwy 16 from Charlotte) If we have units in the community give the directions from the community entrance.

* Required to submit this form

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