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XMULTIPLE ORDER FORM

Only X-RJAX RJ/Coax Connectors may be ordered On-Line. Contact our XMULTIPLE sales representatives, distributors and the XMULTIPLE sales department directly for all other orders.

SOLD

TO                                               

SHIP

TO

Company Name

 

Company Name

 

Street Address

 

Street Address

 

City, State Zip

 

City, State Zip

 

Contact Name, Telephone

 

Contact Name, Telephone

 

SALES ORDER  INFORMATION

CUSTOMER NO.

CUSTOMER PO:

SHIP VIA

TAXABLE

 

     Y/N

RESALE NO.

 

BUYER

 

 

TELEPHONE

TERMS:

REP #:

FOB NEWBURY PARK, CA OR HONG KONG

ITEM   NO.

QTY

MODEL

NUMBER

DUE

DATE

DESCRIPTION

 

UNIT

PRICE

TOTAL AMOUNT

 

 

 

 

 

 

 

 

 

                               Fax Order to 805-498-4003 or Email info@xmultiple.com

                                        XMULTIPLE Technologies

                                   3555 Old Conejo Road   •   Newbury Park, CA  91320

 

 

                                 XMULTIPLE Technologies – The Connection Is On!