POWER-MOTION SALES, INC. ORDER SHEET  

652 Axminister Drive Fenton Mo 63026                                     Phone:636-349-2622   or   Fax:   636-349-2627                                   E-mail:slsales@powermotionsales.com

14004 West 107th Street, Lenexa, KS 66215                  Phone: 913-317-8812 or Fax: 913-317-8839                                   E-Mail: kcsales@powermotionsales.com
SALES 
OFFICE		   
DATE: / / 
BUYER:
PHONE: ( ) - 
FAX: ( ) - 
E-MAIL:
SOLD TO:
COMPANY:
ADDRESS:

CITY: STATE: ZIP: 
SHIP TO:
COMPANY:
ADDRESS:

CITY: STATE: ZIP: 
PAYMENT:     NUMBER: EXP. DATE: / 

 
 

QTY/ PRICE EACH

PART/ MANUFACTURER & DESCRIPTION

QTY: $  Part #:  
Descr: 
QTY: $  Part #:  
Descr: 
QTY: $  Part #:  
Descr: 
QTY: $  Part #:  
Descr: 
QTY: $  Part #:  
Descr: 
QTY: $  Part #:  
Descr: 
QTY: $  Part #:  
Descr: 
QTY: $  Part #:  
Descr: 
QTY: $  Part #:  
Descr: 
QTY: $  Part #:  
Descr: 

Taxable  Ship via:     SPECIFY: