Please fill out all relevant fields with accurate information to complete your order.
Buyer Name: | [Buyer Name] |
Address: | [Buyer Address] |
Number: | [Buyer Number] |
Email: | [Buyer Email] |
Receiver Name: | [Receiver Name] |
Address: | [Receiver Address] |
Number: | [Receiver Number] |
Email: | [Receiver Email] |
Supplies Description | Quantity | Unit Price | Total Price |
---|---|---|---|
All-Purpose Cleaner (1 gal) | 5 | $10.00 | $50.00 |
Microfiber Cleaning Cloths | 10 packs | $8.50 | $85.00 |
Mop Heads | 3 | $15.00 | $45.00 |
Vacuum Cleaner Bags | 2 boxes | $20.00 | $40.00 |
Disposable Gloves | 1 box | $12.00 | $12.00 |
Trash Bags (30 gal) | 4 boxes | $18.00 | $72.00 |
Window Cleaner Spray (32oz) | 8 bottles | $5.00 | $40.00 |
Broom | 2 | $10.00 | $20.00 |
Total | $364.00 |
Payment Method:
Credit Card
Check
Cash
Other:
Billing Address (if different from delivery address): [Billing Address]
Delivery Date Requested: [Delivery Date Requested]
Special Delivery Instructions:
Please deliver the order to the rear entrance of the building between 9:00 AM and 5:00 PM Monday through Friday. |
All sales are final. No returns or exchanges unless goods are defective.
Payment is due upon receipt of invoice unless credit terms have been established.
Late payments are subject to a [X]% late fee per month.
This form serves as an official request for the listed items. By signing below, the customer agrees to the terms and conditions outlined above.
[Buyer Name]
[Date]
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