CMT  PURCHASE ORDER FORM CMTINC.COM
3910 SW 53rd Street
Corvallis, OR 97333 USA

Email: support@cmtinc.com
FAX: (541)752-4117

Company Name: _______________________________________________________
Invoicing Address: Attention: ____________________________
  _______________________________________________________
City ____________________________ State ________________ ZIP _______________
Phone: _______________________ Fax: _______________________
Shipping Address:  Attention: ____________________________
(if different) _______________________________________________________
(No P.O. Boxes please)
City ____________________________ State ________________ ZIP _______________
Phone for Shipping Address: _______________________
Email: __________________________ Contact: (if different) ________________________
CMT Part #

Item / Description

 Qty List Price Extended
______________________ _____________________ ___ ___________ ___________
______________________ _____________________ ___ ___________ ___________
______________________ _____________________ ___ ___________ ___________
Shipping & Handling Charge (per quotation):
___________
  Any duty and taxes are the responsibility of the purchaser.

Total :

 ___________

If purchasing software upgrade or hard key, please provide the serial number from the software CD:
____________________________. Please also specify the type of hard key:
parallel printer port ________, or USB port ________.

Payment Terms (circle):

Net 30
Official P.O. required

Prepaid
by Check

Prepaid
by Wire


We no longer take
credit/debit cards.

PO# (if applicable): 

Authorization :

___________________

______________________

 

Date:____________

 

 

 

Please FAX completed form to (541) 752-4117. Our FAX is secure.
For order assistance call CMT at (541) 752-5456.