Valley Design Order Form

Place an Order

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

NOTE: FIELDS MARKED WITH * ARE REQUIRED

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	PRICE	TOTAL PRICE ($USD)
1
2
3
4
5

ADD MORE ITEMS

TOTAL

$0.00

NOTE: This total does not include shipping charges. Shipping is FOB Shirley, MA.

COMMENTS OR INSTRUCTIONS:

YOUR CONTACT INFORMATION

*COMPANY NAME:

*CONTACT NAME:

* EMAIL:

* CONFIRM EMAIL:

*PHONE NUMBER:

SHIPPING ADDRESS

*COMPANY NAME:

*CONTACT NAME:

* ADDRESS:

ADDRESS 2:

ADDRESS 3:

*CITY:

*COUNTRY:

*STATE:

* ZIP OR POSTAL CODE:

BILLING ADDRESS

SAME AS SHIPPING

*COMPANY NAME:

*CONTACT NAME:

* ADDRESS:

ADDRESS 2:

ADDRESS 3:

*CITY:

*COUNTRY:

*STATE:

* 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:

ACCOUNT #:

SHIPPING:

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.

CREDIT CARD INFORMATION

* NAME ON CARD:

* CARD TYPE:

* ACCOUNT NUMBER:

* EXPIRATION DATE:

* SECURITY CODE (?):

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.

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