You can use this form to place an order if you already have a credit account with us, or if you would like to pay by credit card. New customers who wish to set up a credit account can apply using the account application form. Fields marked with * are required fields.
1). Your company details:
Your name:	*
Tel:	*
Company:
Delivery Address:	*
City:	*
State	* Zip Code: *
2). Payment by:
Credit account:   OKW account No.
Visa Card:   Mastercard:   Amex:   C.O.D.: Card number: Expires:
Card Holder Name:	*
Address:	*
City:	*
State:	* Zip Code: *
Card Holder signature ___________________________________
3). Order Details:
Your order number:
OKW Quotation No.	(if known)
OKW Part # Description Qty Price Delivery date
4). Shipping Method:
Next Day:
2 Day:
3 Day:
Ground:
Priority Mail:
5). Your special Instructions (if required):
Please print this form and fax it to us on (412) 220 9247