| Purchase Requisition for Imprinted Service Order
CSSD #:
CSSD Ref # / P.O. #:
Date:
Ship To:
Street Address: (not P.O Box, for UPS Delivery)
Dealer Order #:
Phone No. of Contact Person:
Contact Person:
E-mail:
Company Imprint:
Address:
Phone No. for Imprint:
Other Imprint Information: (ex. Company Web Address)
Imprint cost includes 5 lines at top and 2 lines on claim check.
Instructions: Forms must be ordered in case lots of 1,000 (minimum order 1,000). Costs do not include shipping. Complete all infomation above and below. Allow 3-4 weeks for delivery. Forward to your Briggs & Stratton Central Sales & Service Distributor.
Please enter a value for each field in the form below. If a number is not required to fulfill your order, please enter a "0" in that field. This form will not be processed if fields are left blank.
Please enter the text from the image below into the text box.
Do not include spaces between words.
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