Dynatect General Order Form

Thank you for choosing to place an order with us! Please complete the form below with the required details to ensure accurate processing and timely delivery of your items. If you have any questions or need assistance, feel free to contact our customer service team. We look forward to serving you.

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Personal Information:

Full Name*

Email*

Phone number*

Purchase Order Number*

Billing Address

Company*

Address*

City*

State / Province*

Zip Code / Postal Code*

Country*

Ship-To Same as Billing Address

Same

Ship-To Address

Company

Address

City

State / Province

Zip Code / Postal Code

Country

Ordering Information

Click the + to add a new line.

List*

Quantity

Price

Customer Part # or Description

Quote Number

Dynatect Part #

Need-By Date

Payment Method*

Credit Card*

Business Account (existing account)

Apply for Terms** (new account)

If you have an existing business account with Dynatect, please confirm your Dynatect approved payment terms:

*For security, do not write the credit card number on this form. Call Customer Service at 262-786-1500 or 800-298-2066 to authorize your card.

To be approved for credit terms a credit application must be completed and our Terms & Conditions of Sale must be agreed to. To Begin the process please email [email protected] or call 262-786-1500 to be directed to your Customer Service Advocate.

Shipping Method

Preferred Small Package Carrier*

Best Way (Freight Prepay & Add to Invoice)

UPS Collect*

FedEx Collect*

Other

*Please provide your Preferred Carrier/Collect Account. Orders shipped Bestway Freight Prepaid & Add will incur a Shipping & Handling Fee.

Preferred Carrier Account Number

Preferred LTL Carrier (provide carrier billing address below):

Bill Attn:

Address

State / Province

Zip Code / Postal Code

Country

Customs Broker

Please provide the name and contact information for your customs broker (required for international shipments)

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Customs Broker Info

(for international orders)

Additional Comments

Anything else you’d like us to know?

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Additional Confirmation Email (optional)

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Dynatect General Order Form

Personal Information:

Billing Address

Ship-To Address

Ordering Information

Shipping Method

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Dynatect General Order Form

Personal Information:

Billing Address

Ship-To Address

Ordering Information

Shipping Method