Solve Needs International / Equipment Company of America (ECOA)

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*Indicates a required field Today's Date: 4-25-2024
*Contact First Name:*Last Name:
*Dept or Title:
*Hours of operation: to
*Have you ordered from us before:Yes No
If so, when was your last order?:

Bill To: (for future use - this form is an inquiry form only)
*Company Name:
*Street Address:
Suite: *City:
*State\Province: *Postal Code:
UPS Zone: *Country:

Use Bill To Address
Ship To: (required for quotes & pricing)
*Street Address:
Suite: *City:
*State/Province: *Postal Code:
UPS Zone: *Country:

Country Code:*Country:
*Main Phone: *Ext: (enter "none" if there is none)
*Direct\Cell Phone: *Ext: (enter "none" if there is none)
*Fax Number:
Email:

*Product Name:
Manufacturer Name:
Model:Year Purchased:Color:
Serial:
*Quantity: *Is this request for New Equipment Used Equipment or Repair Parts
*How did you find us (please include any search terms):
*Comments: (tell us in as much detail as possible, exactly what you need)

For the quickest response please fax this form to 1-248-698-3070 and follow-up with a phone call to 1-248-698-3200 to be sure that your fax was received.

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