| Purchase Requisition for Imprinted Serice 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.
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