Sandown Wireless Quotation Request Form
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Date:_________________
Requesting Agency: Final Ship To:
Name:_______________________________________ Name:_____________________________________
Agency: _____________________________________ Agency: ____________________________________
Address:_____________________________________ Address:____________________________________
City: __________________State:____ Zip:_________ City: ___________________State:____Zip:_______
Telephone: ______________________________ Fax: _______________________________
E-mail: ___________________________________________________________
Type of Equipment/Item: ____________________________________________________
Specific Information: Office Use Only:
Qty--- -Part Number-----------------Description-------------------------Price Each----Item Total
_____ ______________ ___________________________________ _________ ___________
_____ ______________ ___________________________________ _________ __________
_____ ______________ ___________________________________ _________ ___________
_____ ______________ ___________________________________ _________ ___________
_____ ______________ ___________________________________ _________ ___________
_____ ______________ ___________________________________ _________ ___________
Notes: ________________________________________________________________________
________________________________________________________________________
Sub Total Material Cost: ________________
Shipping Charges: ______________________ State Dept. License: ________________________
Quotation Total: _______________________ Office: 603-425-9876 Cell: 603-548-0125
Sandown Wireless, 19 Phillipswood Road, Sandown NH 03876 E-mail: wa1hzk@usa.net