Pianotek Supply Company

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Order Form
You may also order products by filling out and submitting the form below, or click here to download a PDF of the order form and fax it to us at 248-588-9044.

Billing Address
* Required

Customer ID:
*Name:
*Address:
*City:
*State / Province:
*Zip / Postal Code:
Country:
*Telephone:
*Email:

Shipping Address
IF DIFFERENT FROM BILLING

Name:
Address:
City:
State / Province:
Zip / Postal Code:
Country:

Shipping Method
Select One

		UPS Ground		UPS 3 Day
		UPS 2nd Day		UPS Next Day
		Other

Comments:

Qty.	Part Number		Description	Unit Of Measure
		X
		X
		X
		X
		X

Method of Payment

		Use Credit Card On File
		Call Me For Payment Information
		C.O.D.
		Net 30

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Pianotek Supply Company, 740 N. Rochester Rd., Clawson, MI 48017 USA
telephone: 248-588-9055 | fax: 248-588-9044 | service@pianoteksupply.com
TO ORDER: 1-800-347-3854

Order Form You may also order products by filling out and submitting the form below, or click here to download a PDF of the order form and fax it to us at 248-588-9044.

Billing Address * Required

Shipping Address IF DIFFERENT FROM BILLING

Shipping Method Select One

Comments:

Method of Payment

Image VerificationRetype the "word" below in the box provided.

Order Form
You may also order products by filling out and submitting the form below, or click here to download a PDF of the order form and fax it to us at 248-588-9044.

Billing Address
* Required

Shipping Address
IF DIFFERENT FROM BILLING

Shipping Method
Select One

Image Verification
Retype the "word" below in the box provided.