2025 01-20 CC Packet - Laserfiche WebLink

Home

Order Confirmation NOT AN INVOICE Date: Branch #: Sold-To Name: Sold-To Address: City:St/Prov:ZIP/PC:Phone: Contact Person:Email: ZNAT/ZREG:Rep Name:C#: Matrix Account: YES NO Matrix Partner Name:MAM Segment: Service Frequency:Bundle Sold: YES NO Bundle Type: PPE Required: Safety Glasses Ear Plugs Steel Toed Shoes Hard Hat Hi-Viz Vest No PPE Required Other: QUANTITY MATERIAL #DESCRIPTION UNIT PRICE TOTAL 400 Service Charge Your Estimated Total: Customer Signature: Date: Customer Name: Title: INTERNAL USE ONLY Sold-to #Change ID:Window Reset: YES NO Rental Acct: YES NO Payer #Change ID:Y1: Bill-to #Change ID:Install Route:Service Route: # of Employees:DC: Confidential information: This document contains information confidential and proprietary to Cintas Corporation and is the sole property of Cintas Corporation. This document and information contained herein may not be used, disclosed, distributed or reproduced for any purpose, without the prior written authorization of Cintas Corporation and those so authorized may only use the information consistent with the authorization. Reproduction of any section of this document or any attachments hereto must include this legend. FAS Order Confirmation r. 09/22 Delivery/Installation Instructions: I authorize Cintas to verify my credit on Credit.net and/or by contacting the parties provided. I am authorized to sign on behalf of this company. In addition, I authorize Cintas to open a new account on behalf of the company and deliver the products or services listed above at the agreed upon pricing and delivery terms. I authorize Cintas to deliver the additional products or services listed on page 3 at the agreed upon pricing and delivery terms. Page 1 of 3 Gem Lake SELECT ONE SELECT ONE 4 Basic FA $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 4003z_lease Zoll 3 $ 130.50 $ 0.00 4001z_lease Zoll Plus $ 112.50 $ 0.00 Trauma bag small $ 200.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00