Instructions for Completing Offline Order Form


Begin by filling out your store information in the form below. You can navigate fields by using your "tab" key or by using your mouse. To order a product, simply enter the quantity you wish to purchase in the quantity box. When complete, you'll sign the order form with your mouse and click "Download Completed Order Form" at the bottom of this page. Once downloaded, you can either either electronically send your order form to sales@ambess.com, fax it to 814-941-8514 or mail it to 3714 Beale Ave Suite 300, Altoona PA 16601.

Customer Information

Store Name

Store Phone #

Store Fax #

Shipping Address

Billing Address

Address:

Address:

City:

State:

City:

State:

Email Address:

Zip Code:

Email Address:

Zip Code:
Item # Product/Unit UPC Code QTY Cost Pack Unit Cost SRP GP$ GP% Total
Subtotal: $

0.00
Orders shipped to the state of PA add 6% sales tax or submit proof of tax exempt status. $

0.00
Shipping / Handling (Orders under $100) $10.00 $

0.00
FREE Shipping on orders over $100! (Allow 7-10 days for delivery).
Grand Total:
 $

0.00

Payment Options
MC / Visa / Debit
PayPal
Account ACH
Cashier's Check

Card Holder:

Card Number:

MUST BE EXISTING AMBESS
PREPAID CUSTOMER IF
SELECTING ACH OPTION

Ambess Prepaid
3714 Beale Ave Suite 300
Altoona, PA 16601

Expiration Date:

CV Number:

I certify that I have approved this order and that I am authorized to place orders for the location listed above.
Print Name                                                                                                                        Signature                                                                                       Date

Upon examination by manufacturer, if the unit is found to be defective it will be repaired or replaced at no charge. WARRANTY does not apply to defects resulting from any action of the purchaser, including but not limited to mishandling, improper interfacing, operation outside of design limits, improper repair, or unauthorized modification. This WARRANTY is VOID if the unit shows evidence of having been tampered with or shows evidence of being damaged as a result of excessive corrosion; or current, heat, moisture or vibration; improper specification; misapplication; misuse or other operating conditions outside of manufacturer's control. LIMITATION OF LIABILITY The remedies of purchaser are exclusive and the total liability of Ambess with respect to this order, whether based on contract, warranty, negligence, indemnification, strict liability or otherwise, shall not exceed the purchase price of the component upon which liability is based. In no event shall Ambess be liable for consequential, incidental or special damages.

Please sign the above purchase by moving your mouse to the above white block, click and hold the left mouse button while "signing" your name. Your IP address %IP% is being recorded.