CREDIT/PURCHASE ORDER FORM

CREDIT APPLICATION / PURCHASE ORDER FOR TECHNICAL CONSULTING VIA PHONE

User Information

First Name:      
Last Name:       
Title:           
Company:         
Billing address: 
City:

State:           
Country:         
Postal/Zip Code: 
Telephone with country code, city code, and your extension:
Fax with country code, city code etc.   
E-mail:   URL:

Does your company require a purchase order? YES NO

Form Submission (via fax 866-313-6101)

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We analyze first and then repair your electronics to run better than new

^Email sales@cncrepair.com^{,
fax 866-313-6101 , voice 604-888-9050}

^{CNC REPAIR & SALES INC. 413 B 19th ST. #142,
LYNDEN, WA 98264}

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