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Repair Part Order Form

*denotes required fields

 
Customer Acct#
 *Purchase Order #
 
   *Purchase Date
Today
 
      
   (Required for Retailer Only)  
*Ship To Address  Bill To Address  
*Name
 Name
 
*Address
 Address
 
*City
 City
 
*State
 State
 
*Zip
 Zip
 
*Phone
( ) -
 Phone
( ) -
 
 
  
Order Placed By:     
Name
  *Fax Number or email To Receive Order Copy
Phone
( ) -
 

 

 
Email
   
  
 PFI Item NumberQuantityDetailed Part Description 
 
 
 
 

 
 
 
 

 
 
 
 

 
 
 
 

 
 
 
 

 
 
 
 

 
 
 
 

 
 Comments: 
 
 
 

   
 
 
Fax:
(828) 459-9702
 

 
Mail:
Progressive Furniture Inc.
PO Box 308
Archbold, OH 43502
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