MATERIAL REQUEST FORM

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Template Description (not shown in form): Material Request Form

MATERIAL REQUEST FORM

** To avoid delays or discrepancies, please provide as much information as possible. **

FOR PURCHASING USE ONLY

Assigned To: *

REQUESTOR INFORMATION

Type of Requirement: *

First, Last Name *

Tel/Cell: * Best number to reach you.

E-Mail Address Confirmations sent to this email.
+E-Mail

Branch Location *

Truck/Branch No: * XXX-XXXX format

Priority: *

Current Source customer? YesNo

What are we providing? Service + PartsParts Only

Company Credit Card Needed? * NOYES

Vendor Information (required if paying with company credit card)

Note: Using the company credit card to pay for material requirements should be a last resort. Try to use our preferred vendors whenever possible.

Why Credit Card? No Open AccountOn Credit HoldOther/I Don't Know

Vendor Name:

Vendor Point of Contact: (if applicable)

Vendor Fax:

Vendor Tel:

Street Address

Address continued

City

State

Zip

Customer Information (required for Non-Source Customers or must *apply for credit)

Customer Name: *

Customer Tel:

Customer Fax:

Street Address

Address continued

City

State

Zip

Credit Card Payment Information

C.C. Type *

CC #:

Name on Card: *

* Businesses may submit Credit Application to our Accounting Dept.

Note: Parts will not be ordered until Credit Application has been approved. If a business cannot wait, then they must pay with a credit card.

JOB/W.O. INFORMATION

Job No: *

Store Name & No: *

W.O. #: *

Store Name & #: *

Request For Quote Section(RFQ)

Store Name & No: *

HARDT PART(S) INFORMATION

Part No. *

Description *

Qty *

+item

RETURN SHIPPING INSTRUCTIONS

Ship FROM Information

Where is/are part(s) shipping FROM? Source BranchOther

What branch? *

Street Address

Address continued

City

State

Zip

Ship TO Information

Where is/are part(s) shipping TO? Source BranchVendor/Mfg

What branch? *

Attention To:

Street Address

Address continued

City

State

Zip

Shipping Method

*
GROUND: 1–5 business days based on distance to your destination
EXPRESS: 3 business days by 4:30 p.m. to most areas (by 7 p.m. to residences)
2 DAY AIR: 2 business days by 4:30 p.m. to most areas (by 7 p.m. to residences)
OVERNIGHT STD: Next business day by 3 p.m. to most areas
OVERNIGHT AM: Next business day by 10:30 a.m. to most areas

RETURN PART(S) SPECIAL INSTRUCTIONS/REMARKS

ITEM REQUIREMENTS

Mfg/Vendor

Model Number

Serial Number

4-Digit or Mfg P/N

Description *

Qty *

UofM

Unit Price

Is This Part Under Warranty? * YesNoI Don't Know

+Attachments + Attachment

Add Another Item

** To avoid delays or discrepancies, please provide as much information as possible. **

SPECIAL INSTRUCTIONS/REMARKS