Direct Prepaid Order Form Customer ID (returning customers) EIN Company Name Telephone Address City State/Province Zip/Postal Country Tax_Exempt Tax_Exempt Yes ( If yes, tax-exempt certificate must be sent to Orders@automatedeleparts.com. Failure to provide tax tax-exempt certificate may result in being charged sales tax. ) No Quote Number Order Confirmation Email Address PO Number PO Total Shipping Method Shipping Method Collect Prepay and Add Carrier Account Number Ship to Company Name (if different) Attn Address City State/Province ZIP/Postal Code Special Instructions Payment Method Payment Method Credit Card ACH/Wire Check by Mail Option 1 Option 1 A link for credit card payment will be emailed to the order confirmation email address unless specified otherwise. Option 2 Option 2 Bank payment instructions will be emailed to the order confirmation email address unless specified otherwise. Option 3 Option 3 Please remit to : 1999 Edison Hwy Suite 13, Bakersfield, CA 93305 Authorized Name Date Title 4 + 1 = Submit