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 Taylor Preventive Maintenance Tune Up Kit Parts Program
Please sign me up for the Preventive Maintenance "Tune Up Kit" Parts Program and automatically ship
the items to me at the interval indicated below. I hereby authorize Taylor Equipment Distributors, Inc.
to charge my credit card or my account for products or services as provided.
Model #: _________________________ Serial #: _______________________________
| ITEM |
QUANTITY |
FREQUENCY |
| Tune Up Kit |
|
Quarterly |
| Scraper Blades |
|
Quarterly |
| Brush Kit |
|
Semi Annually |
| Taylor Lube |
|
Quarterly |
| Sanitizer |
|
Quarterly |
Location/Business Name_______________________________________________
Street: ______________________________________________________________________
City:________________________________________________ State: ___________________
Zip Code: ___________ - _________ Telephone: ( ) _____ - _________
Fax: ( ) _____ - _________ Email ___________________________
Signature____________________________ Date _____________
Printed Name ___________________________________________
Credit Card: ( ) VISA ( ) MasterCard Expiration Date: ______ /______
Name on Credit Card ___________________________________________________________
Credit Card Number: ______________________________________ Security Code __________
Credit Card Billing Address (if different from above):
Street: ____________________________________________________________________
City:________________________________________________ State: _________________
Zip Code: ___________ - _________ Telephone: ( ) _____ - _________
Fax Credit Card Transaction Receipt to Fax Number: ( ) _____ - _________
Bill to my Account # ______________________________________
If you have any questions please contact the Parts Department at 301-773-2700.
PLEASE FAX THIS COMPLETED FORM TO 301-773-2720.
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