Instructions: Print this form and fax or mail the completed form to our address below,    or Fill out and submit electronically by clicking on the submit button below.   (A customer service representative will call to confirm submitted orders)   4080 N. 20th Avenue       Wausau, WI 54401 TEL: 715-675-2084    TOLL FREE: 1-800-310-9594    FAX: 715-675-5507 mail@NPSwausau.com    www.npswausau.com Complete Fueling Systems - Canopies - Tank/Line & Cathodic Testing - Hoists - Tank Removals
Contact Information:
	SOLD TO:	SHIPPED TO (If different):
Name
Address Line 1
Address Line 2
City, State, Zip
Phone
Fax
E-mail

Customer #	Customer PO #	NPS Salesperson	Cash	C.O.D.

Charge	MDSE Retd	Dept.	G/L

Order Information:
Quantity Ordered	Part No.	Description	Unit Price	Extended Price
	Comments		Sub Total
	Special terms		Sales Tax
			TOTAL
The sale of the above described merchandise from NPS to purrchaser shall be controlled by the following agreements, terms, and conditions: 1. The terms of payment are cash in full within 30 days from the date of delivery, including freight charges unless otherwise stated above. All applicable finance charges apply. 2. The title to and right of possession of the merchandise furnished by the seller and above described shall remain in the seller, said merchandise shall remain personal property of the seller until paid for in full, and the buyer shall do all acts necessary to perfect and maintain such right and title in the seller.   By clicking on the submit button, the buyer approves the above agreement and accepts all conditions.