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Wexco On-line Order form

Bill to Information Ship to Information
Order Date: PO Number:
Your Name: Attention:
Job Title: Company:
Company: Address 1:
Address 1: Address 2:
Address 2: City:
City: State/Prov:
State/Prov: Zipcode:
Zipcode: Country:
Country: Freight Carrier:
Telephone: Date Requested By:
Fax: Print Number:
Email: Wexco Quote #:
Terms: To be determined Quote Issue Date:
Expert Broker
Special Shipping Instructions
Wexco Drawing Number
Qty
Description
(include ID, OD , length, machine make and model, inlay)
Quoted price

Please include all necessary technical information, drawings, prints etc.
Attach documents with the order
All orders are subject to Wexco terms and conditions of sale. Acceptance and payment terms will be acknowledged upon receipt and confirmation of the order. Ship dates are subject to change pending receipt of all technical information to process the order.

Wexco Corporation - 1015 Dillard Drive - Lynchburg, VA 24502
(800) 999-3926