E-Z Quote/Order Form



Falcon Direct E-Z Order Form

With the proliferation of Spam, fraud, and difficulties in maintaining current on-line catalogs, we have developed a new quote/order system called E-Z Order for security, simplicity, and your satisfaction. To make things easier for all of us, please fill in the blanks with your word processor. Here is your first step.

|Tell us about yourself |

Please complete the following information for a quote or when placing an order.

|Name |      |Organization |      |

|Shipping Address |      |City/State/Zip |      |

|Daytime phone |      |Fax number |      |

|Billing address |      |City/State/Zip |      |

|Email address |      |Type entity | Gov’t Institutional Business |

|To place an order |

|Please specify payment method. If you are purchasing by | Check with order, Credit Card, Purchase order |

|Purchase Order, our terms are Net 10 days to approved |Your purchase order number?       |

|accounts. |American Express , Discover , MasterCard , or VISA |

|If paying by credit card, will you be using an |Expiration date       Security code       Note: Security code is 3 digit |

|Name on card       |number on back of card or 4 digits on the front of American Express. Please |

|Card Number       |enter your order below: |

|Please enter your credit card billing address here       |

|Qty |Part Number |Description |Unit Price |Total |

|      |      |      |$      |$      |

|      |      |      |$      |$      |

|      |      |      |$      |$      |

|      |      |      |$      |$      |

|      |      |      |$      |$      |

|      |      |      |$      |$      |

| |Desired programming | | | |

| |information |Rx Freq.       Rx Tone       Tx Freq       Tx Tone       | | |

| | | | | |

| | |Paging tones       (See also block below to insert more info.) | | |

| | | | | |

|How would you like for us to ship? | UPS ground 2 day 3 day Overnight? |TOTAL $      |

|Provide additional |      |

|information here | |

Last – Send us an email containing a unique 8 digit ID name that will become your electronic signature, your organization and your Federal ID number if you are a business or governmental account. Email this completed form to ezform@ or fax to 205.853.6178. Remember, we will need your ID Name      , Organization       and Federal ID Number       (Not required for individuals). If you have any questions, please call us at 1.800.489.2611. Thank you!

           

Electronic signature or personal signature if faxing Date

Copyright 2007 E-Z Order Form.dot

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User information. Credit cards are subject to a 3% surcharge. Shipping and taxes (if applicable) will be added and shown on your order confirmation. See 4u.us/shipping.pdf. Products sold by Falcon Direct are warranted to be technically compliant with the manufacturers specifications.  No other warranty relative to use of the equipment or related service, when applicable, is expressed or implied.  Falcon Direct makes no claim for suitability or fitness of users purpose or application.  Falcon Direct is not responsible for claims arising from the use of equipment or services provided by or through Falcon Direct in which there are losses attributed to the use or application of equipment and/or related services.  User agrees to these terms as a condition of purchase. Return policy is available at 4u.us/returns.pdf. Warranty information – 4u.us/warranty.pdf

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