Purchase Order Submission Form

Leyshon Miller Industries, Inc.

534 N. First St.

Cambridge, OH 43725

740-432-2969 FAX 432-8865

 
* Denotes a Required Field

This order is not valid until received, approved and confirmed by LMI accounts receivable department.

 

Buyer/Contact:

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Company Name:

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Billling Address:

City:

State/Zip:

Shipping Address:

City:

State/Zip

Phone #:

Fax #:

Email Address:

 *

LMI Quote Number:

 *

Your Purchase Order Number:

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Terms:

Qty:

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Part Number:

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Description:

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Price Each:

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Purchase Order Total:

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Date Required:

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Ship Via:

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