Organ Service Corporation

Secure Parts Order Form

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Use this form to submit orders to Organ Service Corporation via the Internet. Please fill out the form as completely as possible and be sure to provide the contact information in case we have a question about your order.

This a secure form, however, if you do not feel comfortable sending your credit card information via the internet you may call our office at 800-457-4408 and place your order by phone.

Orders received before noon are generally shipped same day. If you do not have a part number, please call our office at 800-457-4408 for help in identifying the part. Please have the make, model number, etc of the organ available when you call.

We have a $15.00 minimum parts order , not including shipping. Please insure that your order meets this minimum so there will be no delays in processing. This minimum does not apply to literature (owner's manuals, service manuals, etc).

Please provide the following ordering information:

QTY PART NUMBER DESCRIPTION PRICE EACH

Ship available items, backorder out of stock items.

Hold order if some items out of stock. Ship complete.

COMMENTS / SPECIAL INSTRUCTIONS

BILLING INFORMATION

Method of Payment*

Cardholder Name

Account/Card Number**

Expiration Date Type "Open" for net accounts

*Note: Net Accounts available to qualified service centers only!

**PayPal users enter the email address you use for your account in the Account/Card Number field. Open accounts enter your Organ Service Corp account number here.

SHIPPING ADDRESS

Street Address

Address (cont.)

City

State/Province

Zip/Postal Code

Country

Method of Shipment

BILLING ADDRESS

Name

Title

Organization

Street Address

Address (cont.)

City

State/Province

Zip/Postal Code

Country

Work Phone

FAX

*E-mail

URL

*Providing your email address will allow us to automatically provide you with UPS tracking information. You will then be able to check the status of your order in transit. We respect your privacy and do not make email addresses available to third parties

Copyright © 2001 Organ Service Corporation. All rights reserved.

Revised: July 01, 2001

Organ Service Corporation

BILLING INFORMATION
Method of Payment*
Cardholder Name
Account/Card Number**
Expiration Date	Type "Open" for net accounts

SHIPPING ADDRESS
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Method of Shipment

BILLING ADDRESS
Name
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
FAX
*E-mail
URL