RAIS Form Order Spare Parts Stoves vers 1.1 2005-10

RAIS Form Order Spare Parts Stoves vers 1.1 2005-10

ORDER FORM: SPARE PARTS, STOVES & INSERTS
RAIS Form Order Spare Parts Stoves vers 1.1 2005-10.doc
Please forward order via e-mail to: [email protected] or telefax to: (646)282-0010
Rais Dealer (account)
Dealer name
Dealer contact name
Date of filling in order form
Address
City
State
ZIP
Ship to Delivery Address
Dealer account
Warehouse
Installer
End user
Pick up by dealers freighter
Pick-up by dealers own van
Name
Address
City
State
ZIP
Shipping Information
Requested delivery date (arrival)
Delivery Contact Name
Delivery Contact Phone
Truck Lift Gate Service
Yes
No
Method of Payment
Credit Card
MC
Credit card no.
Exp.
Visa
AE
Diners
Rais draws amount on date of
shipping from warehouse
Signature
Bank transfer
Bank check
30 days net
Prepaym. -2%
Terms of payment
Order Specification
Spare Parts for Stoves and Fireplaces
(please enter a number in qty.)
Stove
Qty
RAIS Gabo Gas
Conv. Kit
Natural to LP
RAIS Gabo Wood
Gaskets, set
Qty
Qty
Qty
Qty
Qty
Glass
Baffle plate
Vermaculite,
bottom
Vermaculite,
sides + back
Glass
Door handle
Vermaculite,
sides + back
Glass
Door handle
RAIS Pina
Gaskets, set
Baffle plate
Vermaculite,
bottom
RAIS Vola
Gaskets, set
Baffle plate
Vermaculite,
bottom
Vermaculite,
sides + back
Glass
Door handle
RAIS Mino
Gaskets, set
Baffle plate
Vermaculite,
bottom
Vermaculite,
sides + back
Glass
Door handle
Vermaculite,
sides + back
Glass
Door handle
RAIS Malta
Gaskets, set
Baffle plate
Vermaculite,
bottom
RAIS Bando
Gaskets, set
Baffle plate
Vermaculite,
bottom
Vermaculite,
sides + back
Glass
Door handle
Vermaculite,
sides + back
Glass
Door handle
RAIS Bora
Gaskets, set
Baffle plate
Vermaculite,
bottom
RAIS Arena
Gaskets, set
Baffle plate
Vermaculite,
bottom
Vermaculite,
sides + back
Glass
Door handle
RAIS Atlas
Gaskets, set
Baffle plate
Vermaculite,
bottom
Vermaculite,
sides + back
Glass
Door handle
Vermaculite,
sides + back
Glass
Door handle
RAIS Komba
Gaskets, set
Baffle plate
Vermaculite,
bottom
RAIS Classic 86
Gaskets, set
Baffle plate
Vermaculite,
bottom
Vermaculite,
sides + back
Glass
Door handle
Vermaculite,
sides + back
Glass, set
Door handle
Vermaculite,
sides + back
Glass
Door handle
RAIS Classic 106
Gaskets, set
Baffle plate
Vermaculite,
bottom
RAIS 60 Insert
Gaskets, set
Baffle plate
Vermaculite,
bottom
Qty
Conv. Kit
Pilot + Burner
Rais Dealer Service, Denmark, E-mail: [email protected], telefax: 011 45 9847 9291, telephone: 011 45 9847 9033