MMS MILLER MECHANICAL SPECIALTIES INC.
 
Des Moines Office
P.O. Box 1613 (50306)
510 Murphy Street (50309)
Des Moines, IA
(515) 243-4287 phone
(515) 243-7313 fax
Quad Cities Office
P.O. Box 1
129 North Cody Rd.
Le Claire, IA 52753
(563) 289-3037 phone
(563) 289-3038 fax
Omaha Office
 
2541 North 160th Street
Omaha, NE 68116
(402) 891-6653 phone
(402) 891-1477 fax
 
  Place Purchase Order    
  Instructions:    
   

You may place an order with us via email. If you have an MMS quote number please note it below, if not please go to Get A Quote and we will evaluate your service conditions and provide a quote.
 

 
  Contact Information:    
   

Name:  
Address: City: State: ZIP:
Ship To Information (if different from above):
Address: City: State: ZIP:
Phone: FAX:
Email:

 
 
  Quote Info:    
 

MMS Quote Number:
Buy Exactly As Quoted? Yes   No
  (if Yes, skip below, if No, fill out below)

 

 
  Item Information:    
  (If you do not know the Model or P/N go to "Get A Quote")

Manufacturer:
Model or Part #:
Quantity:
Description:

 

 
  Note:    
 

You will receive an immediate email confirmation of our receipt of this form.
 

 
     
 

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Page Contents © 2007 Miller Mechanical Specialties, Inc.
File last modified October 30 2007 09:39:51 AM