Federal Government Order FormPlease visit our Global GSA Website

DOES THIS ORDER UTILIZE GSA CONTRACT # GS-03F-076GA? YES NO

IF YES: Is the GSA Contract # clearly identified on this order? YES

IF NO: Is open market clearly identified on this order? YES

ORDER TYPE:

DID YOU ATTACH THE APPROPRIATE DOCUMENTATION, AS APPLICABLE? YES

THIRD PARTY BILL? YES

IS THIS A CREDIT CARD ORDER? YES

NO

NO (if YES, the credit card form must be faxed securely or “Call for Card Info”)

WERE THE APPROPRIATE HANDLING CHARGES ADDED TO THIS ORDER? YES N/A

SPECIFICATION PROJECT #: SIF FILE ATTACHED? YES NO

WEB QUOTE #:

EVOLVE PRICE LIST: EVOLVE DISCOUNT APPLIED:

GLOBAL PRICE LIST: GLOBAL DISCOUNT APPLIED:

REQUEST ARRIVAL DATE:

SPECIAL NOTES:

GSA ELIGIBLE ENTITY INFORMATION:

END USER:

PROJECT NAME:

PO#: TOTAL PO $:

PHONE #: FAX #:

KEY CONTACT:

CUSTOMER EMAIL:

SERVICE ITEMS ON PURCHASE ORDER:

INSTALLATION $:

IS INSTALLATION 27% OR LESS

OF THE NET PRODUCT PRICE? YES NO

If NO,did Global receive GSA’s Approval?* YES

SHIP COMPLETE? YES NO

DEALER INFORMATION:

DEALER OF RECORD:

DEALER SALES REP:

PO#: KEY CODE:

PHONE #: FAX #:

KEY CONTACT:

DEALER EMAIL:

SHIP TO INFORMATION:

COMPANY NAME:

ADDRESS:

CITY:

STATE: ZIP:

CONTACT NAME:

PHONE #:

US DRIVER REQUIRED? YES NO

DELIVERY PAPERWORK ATTACHED? YES NO

IS THERE A DOCK?** YES NO

*Installation rates that exceed 27% of the net product price may be accepted underextenuating circumstances (ex: Union labor, stair carry, after hours, etc.). Globalrequires our Contracting Officers approval on this amount prior to acceptance ofthe order.**If a lift-gate truck is required, additional charges may apply.

CCR

SQ #

Date of Processing:

DEALER

3RD

DEALER DISCOUNT:

INTERNAL GLOBAL USE ONLY

For current lead times, see Dealer Website

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