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
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
*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.
If carrier is Other, please specify:
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
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.