Place An Order

Please use this form to place an order with a credit card. If you have not received a quote, please request a quote here. If you would like to submit a purchase order, please email us directly at info@valleydesign.com.

• QUOTE NUMBER &
  PRODUCT INFO
• YOUR CONTACT
  INFORMATION
• SHIPPING ADDRESS &
  BILLING ADDRESS
• PAYMENT INFO

QUOTE NUMBER

* QUOTE NUMBER:

(QUOTE FORMAT XX.XXXX.XX OR XXXX)

QUOTE NUMBER REV

(IF APPLICABLE - Example: A, B, C or 1, 2, 3)

PROVIDE YOUR ITEM, QUANTITY AND PRICE

You Can Find This Information In Your Quote. Prices Are In $USD

* PART NUMBER

* QUANTITY

Lot Charge

PRICE

TOTAL PRICE ($USD)

Yes No

Yes No

Yes No

Yes No

Yes No

ADD MORE ITEMS

TOTAL

$0.00

NOTE: This Total Does Not Include Shipping Charges. Shipping Is FOB Shirley, MA.

COMMENTS OR INSTRUCTIONS:

CONTINUE

YOUR CONTACT INFORMATION

*COMPANY NAME:

*CONTACT NAME:

* EMAIL:

* CONFIRM EMAIL:

*PHONE NUMBER:

CONTINUE

SHIPPING ADDRESS

*COMPANY NAME:

*CONTACT NAME:

* ADDRESS:

ADDRESS 2:

ADDRESS 3:

*CITY:

*COUNTRY: Select Country Afghanistan Albania Algeria American Samoa Angola Anguilla Antartica Antigua and Barbuda Argentina Armenia Aruba Ashmore and Cartier Island Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil British Virgin Islands Brunei Bulgaria Burkina Faso Burma Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Clipperton Island Cocos (Keeling) Islands Colombia Comoros Congo, Democratic Republic of the Congo, Republic of the Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Cyprus Czeck Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Europa Island Falkland Islands (Islas Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern and Antarctic Lands Gabon Gambia, The Gaza Strip Georgia Germany Ghana Gibraltar Glorioso Islands Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See (Vatican City) Honduras Hong Kong Howland Island Hungary Iceland India Indonesia Iran Iraq Ireland Ireland, Northern Israel Italy Jamaica Jan Mayen Japan Jarvis Island Jersey Johnston Atoll Jordan Juan de Nova Island Kazakhstan Kenya Kiribati Korea, North Korea, South Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia, Former Yugoslav Republic of Madagascar Malawi Malaysia Maldives Mali Malta Man, Isle of Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States of Midway Islands Moldova Monaco Mongolia Montserrat Morocco Mozambique Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcaim Islands Poland Portugal Puerto Rico Qatar Reunion Romainia Russia Rwanda Saint Helena Saint Kitts and Nevis Saint Lucia Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Scotland Senegal Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and South Sandwich Islands Spain Spratly Islands Sri Lanka Sudan Suriname Svalbard Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Tobago Toga Tokelau Tonga Trinidad Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom Uruguay USA Uzbekistan Vanuatu Venezuela Vietnam Virgin Islands Wales Wallis and Futuna West Bank Western Sahara Yemen Yugoslavia Zambia Zimbabwe

*STATE: Please select country first

* ZIP OR POSTAL CODE:

BILLING ADDRESS

SAME AS SHIPPING

*COMPANY NAME:

*CONTACT NAME:

* ADDRESS:

ADDRESS 2:

ADDRESS 3:

*CITY:

*COUNTRY: Select Country Afghanistan Albania Algeria American Samoa Angola Anguilla Antartica Antigua and Barbuda Argentina Armenia Aruba Ashmore and Cartier Island Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil British Virgin Islands Brunei Bulgaria Burkina Faso Burma Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Clipperton Island Cocos (Keeling) Islands Colombia Comoros Congo, Democratic Republic of the Congo, Republic of the Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Cyprus Czeck Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Europa Island Falkland Islands (Islas Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern and Antarctic Lands Gabon Gambia, The Gaza Strip Georgia Germany Ghana Gibraltar Glorioso Islands Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See (Vatican City) Honduras Hong Kong Howland Island Hungary Iceland India Indonesia Iran Iraq Ireland Ireland, Northern Israel Italy Jamaica Jan Mayen Japan Jarvis Island Jersey Johnston Atoll Jordan Juan de Nova Island Kazakhstan Kenya Kiribati Korea, North Korea, South Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia, Former Yugoslav Republic of Madagascar Malawi Malaysia Maldives Mali Malta Man, Isle of Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States of Midway Islands Moldova Monaco Mongolia Montserrat Morocco Mozambique Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcaim Islands Poland Portugal Puerto Rico Qatar Reunion Romainia Russia Rwanda Saint Helena Saint Kitts and Nevis Saint Lucia Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Scotland Senegal Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and South Sandwich Islands Spain Spratly Islands Sri Lanka Sudan Suriname Svalbard Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Tobago Toga Tokelau Tonga Trinidad Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom Uruguay USA Uzbekistan Vanuatu Venezuela Vietnam Virgin Islands Wales Wallis and Futuna West Bank Western Sahara Yemen Yugoslavia Zambia Zimbabwe

*STATE: Please select country first

* ZIP OR POSTAL CODE:

SHIPPING INFORMATION

Our Default Carrier Is UPS. If You Prefer To Use Another Carrier, Please Provide Your Account Information Below.

CARRIER: UPS Federal Express DHL Pick-up Other

ACCOUNT #:

SHIPPING Priority Overnight Overnight 2nd Day 3rd Day Ground

If Carrier Is Other, Please Specify:

COMMENTS OR SPECIAL INSTRUCTIONS:

NOTE: Shipping Terms Are Prepaid. Actual Shipping Charges Will Be Calculated And Charged To Your Credit Card When Your Order Is Shipped. Shipping Is FOB Shirley, MA.

CONTINUE

 Credit Card

 Pay on Call

Please submit the form and call us.

CREDIT CARD INFORMATION

* NAME ON CARD:

* CARD TYPE: Select MASTER CARD VISA CARD AMEX CARD

* ACCOUNT NUMBER:

* EXPIRATION DATE: Select Month 1 2 3 4 5 6 7 8 9 10 11 12

SELECT YEAR Select Year 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033

* SECURITY CODE (?):

Submit

Thank you for getting in touch! We appreciate you contacting us

NOTE: NOTE: If Your Form Does Not Submit Please Verify That Quote Numbers And Contact Information Have Been Completed. You Should Be Taken To A Confirmation Page Where You Can Review Your Order.

NOTE: FIELDS MARKED WITH * ARE REQUIRED