Customer Order Form

Welcome Pioneer Customers!

We've added this page for our established customers who wish to order on-line.
In order for this page to work, you must have previously ordered from us, and wish
to order by your pre-established credit line.

To use a credit card, order directly from the "catalog" page

If you wish to establish a credit account, please call us.
(800) 951-1551 8AM-4PM Central Time

For information regarding pricing or case quantities,
please refer to the current Price List

Req. = Required information (if you don't know your Customer Number,
fill in all information and note that you are a current customer in the comments box.

Your 6 -digit Customer Number Req.
Organization's Name
Your Name Req.
Phone number (if we have a question)
Today's Date
Purchase Order Number
Your E-mail address Req.

*Place your orders below:*	*Item Number*	Quantity (pieces) *
First Item (Part Number - Quantity)
Second Item (Part Number - Quantity)
Third Item (Part Number - Quantity)
Fourth Item (Part Number - Quantity)
Fifth Item (Part Number - Quantity)

* be sure to order pieces in case-pack amounts. Quantities other than full-cases require special packaging and
will be charged at retail price rather than wholesale.

Thank you for your order, we will confirm by fax, e-mail or phone

NOTES:

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