Order Form
Use this form to organize your order before calling.
Call: 800-328-8996 7:30 am - 5:00 pm (Central) Monday-Friday Email: sales@atsclock.com Fax: 800-789-1882 Mail: American Time, 140 3rd St So., PO Box 707, Dassel, MN 55325-0707
Customer Number: _ __________________________ Date: ______________________________ Purchase Order Number: __________________________________________________________ Authorized Signature: ____________________________________________________________ Title: ______________________________ Bill To: Company Name: ___________________________________________________________________________________________________ Attn: _______________________________________________________________ Dept: _ _____________________________ Address: ___________________________________________________________________________________________________ City: _________________________________________________ State _ ___________ Zip: ____________________________ Phone: ___________________________ Fax: _ ______________________ Email: ________________________________________ Ship To: Same as above □ Company Name: ___________________________________________________________________________________________________ Attn: _______________________________________________________________ Dept: _ _____________________________ Address: ___________________________________________________________________________________________________ City: _________________________________________________ State _ ___________ Zip: ____________________________ Phone: ___________________________ Fax: _ ______________________ Email: ________________________________________ Payment Method: □ Prepay □ Send Invoice (need credit approval) If you would like to use a credit card, please call 800-328-8996 or order online at american-time.com. We accept VISA, MasterCard, Discover and American Express. All items shipped “Best Way” unless otherwise instructed.
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Quantity
Part Number
Voltage
Description
Unit Price Total
I would like to receive your catalog □ YES □ NO
Sutotal Shipping
*Sales tax will be added when applicable. Prices subject to change without notice. Visit our website for current pricing.
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*Total
ORDER BY FAX 800-789-1882 ORDER BY PHONE 800-328-8996 ORDER ONLINE american-time.com
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