Scott Batteries Order Form
1041 W. 18th St., Costa Mesa, Ca. 92627 USA
FAX Orders To: 949 258-5288, Office Call: 949 646-8191
Email Correspondence to: cthompson@scottbatteries.com
To place your order, fill out this form and fax it to our corporate office or save it to your hard drive and email as an
attachment to Scott Batteries or send via US Postal Service.
Please Print or Type Clearly, All Information Required
Sold To: (Credit Card Billing Address) Ship To: (Final Destination)
Company Name:_________________________________ Company Name:_______________________________
Company Contact:_______________________________ Site Contact:___________________________________
Address:________________________________________ Address:______________________________________
________________________________________ ______________________________________
City:___________________ State:______Zip:_________ City:___________________ State:______Zip:_________
Telephone: __________________________ Fax: _______________________ e-mail: _________________________
Purchase Order Number (for receiving purposes): ______________
Note: Scott Batteries does not ship to PO boxes.
Payment Method:
Credit Card Order ____Check Enclosed ____ Money Order Enclosed ____
Master Card: ___ Visa: ___ Discover: ___ American Express:___
Card Number: _______________________________________________________________
Exp. Date: __________________ Name On Card: __________________________________
Signature (Required if using Credit Card) ________________________________________
Qty Part Number Description Price Each Item Total
_____ ______________ ___________________________________ _________ ___________
_____ ______________ ___________________________________ _________ ___________
_____ ______________ ___________________________________ _________ ___________
_____ ______________ ___________________________________ _________ ___________
_____ ______________ ___________________________________ _________ ___________
Sub Total Order Cost Before Shipping: $ ____________
Shipping: All orders are F.O.B. Factory, Chino, California. The cost of shipping is determined by Scott Batteries after receiving
order. Shipping cost on all orders is a prepay and add.
All orders to be shipped via Fed Ex Ground service, UPS surface or LTL carrier, unless requested otherwise.
To determine shipping costs in advance of order, email us the order and we will inform you of the exact shipping cost. Email to
cthompson@scottbatteries.com
Corporate Accounts: Please include a company purchase order along with your Scott Batteries Order Form. Corporate
accounts are provided open account status, only after review by the Scott Batteries Credit Department.
Federal, State, County Government and Education Orders: Please include a purchase order along with your Scott Batteries
Order Form. Government and Educational accounts are provided open account status, only after review by the Scott Batteries
Credit Department.
Dealers and Volume Customers: Please call for special pricing and shipping arraignments.
Sales Tax: Sales tax will be added to all order generated by companies in the state of California, unless a California State Resale
Certificate is provided.
To pay by check or money order: Make check payable to Scott Batteries.
International Sales and Payment Method: Outside the U.S., pay via postal money order, cable or credit card. If payment if
made via money order, make check in US$ payable to Scott Batteries.
If by cable, email us for routing and account number specifics, then fax your order indicating the amount wired, date, and other
relevant information to 001 909 591-5212.
For shipments outside the U.S., we ship via DHL courier.
Scott Batteries Private Information Policy Statement: Corporate or personal information is never provided to any person
outside our organization. If you feel uncomfortable sending specific information via fax or over the internet, please call Scott
Batteries directly.
Every effort is made to protect the privacy and security of our customers.