Printable/Faxable
ORDER FORM
To place an order via fax or regular mail, complete the form below, print it and then fax or mail it us. You may also open this form in your favorite word processor, and email it to us. If you have any questions or comments about this form, please contact us.

 

Rudolph Information Systems and Equipment, Inc.
1585 Sulphur Spring Road
Baltimore, MD

410-242-2100
410 242-2105 Fax

Name
Address
City State

shipto.gif (1076 bytes)

 Name
Address
City State

Customer Order No. Salesman
Cash C.O.D.
Charge Credit
F.O.B. Terms Date
Quantity Description Price Amount
1          
2          
3          
4          
5          
6          
7          
8          
9          
10          

Mdse. Retd.

Paid Out

Received By

TOTAL

 $  

This slip must accompany all claims and returned goods

Rudolph Information Systems & Equipment, Inc.