Purchase Order

Print, fill it out and fax to (818)886-3436. Back home			Purchase Order
Company Name:______________________________ Address:_____________________________________ City:________________________________________ State:_______________________________________ Zip:_________________________________________ Phone:_______________________________________ Fax:_________________________________________ Contact:_____________________________________ Email:_______________________________________			P/O#:
			Date:
			Ship By: -FedEx 2 day $8.50 ( USA ) -FedEx O/N $14.00 ( USA )
			Terms:
Please fax to: New Image Data, Inc. (818)886-3436 - DLT, DAT drives, parts and repairs
Item	Description			Qty	Price
DL07	DLT7000 leader (5 pack)				$90
DL04	DLT4000/2000XT leader (5 pack)				$90
DL01	DLT1 / VS80(5 Pack)				$90
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Sub Total
Shipping & Handling
Tax
TOTAL

Payment Details		Please indicate your resale number:
Circle only one		Purchaser _________________
Company Check
Casher Check
Wire Transfer
Credit Card (If credit card, please continue with CC info)
Credit Card Name (VISA, MC or AMERICAN EXPRESS ONLY)
Card Holders Name
Card Number
Exp Date