May 2009 Service Parts fax Order Form FAX TO: (888) 274-6192 OR TOLL FREE:
877-367-5606 Please fill out completely Date _________________________________ Account Number _______________________________ Your Name ______________________________ Your Fax Number _____________________________ Bill To _________________________________ Ship To ___________________________________ _________________________________ Your Phone Number ____________________________ _________________________________ ___________________________________ remove this page and make copies remove this page and make copies _________________________________ ___________________________________ Purchase Order Number ____________________ Ship Via ___________________________________ _________________________________ ___________________________________ Model(s) ______________________________________________________ Serial No.(s) _________________ Optional Equipment __________________________________________________________________________ All backordered parts will be shipped when available via the same ship method as the original order unless noted below:
o Ship complete order only - no backorders o Ship all available parts and contact customer on disposition of backordered parts o Other (please specify) F OR TEREX U SE O NLY Order Number ______________ Origin Code ________________ Comments _________________________ RL4000 • TML-4000 Part No. 116444 Date Scheduled ____________ Ship Condition ______________ __________________________________ Order Total ________________ Terms Code________________ __________________________________ Part Number Description Quantity Price