~ NEW Customers OR Account Changes~ PLACE AN ORDER

ATTENTION:Online ordering with Custom Inventory Systems utilizes pop-up windows. Please allow pop-up function for this site or you turn off your pop-up blocker while placing an order. You will receive a pop-up confirmation after you submit your order. This order form is to be used if you wish to open a new account, or to make changes to an existing account. Your assigned customer ID will be in the top right corner of your invoice.  Keep this ID number handy for future orders. If you already have a Customer ID number, you can use the "Established Customer" order page and save steps. ALL FIELDS NOTED WITH AN * ARE REQUIRED, orders can not be filled unless all information is given. NOTE: Please use the tab key to move through each of the fields. Do not use the enter key, or your form may be submitted complete. When you have completed the form, click the submit button.

GENERAL INFORMATION * Your First Name: * Your Last Name: * Your Job Title: * Email Address:  (company email address only) * Restaurant/Company Name: Unit/Store Number: * What type of Restaurant/Company are you? Part of multi-unit or chain restaurant group (franchise) Part of mulit-unit or chain restaurants (Corp owned) Single unit/stand alone restaurant Non-Restuarant Company, part of multi-unit/chain Non-Restaurant Company, single unit Wholesaler SHIPPING INFORMATION * Shipping Name of Company: Shipping Attention of: * Shipping Address (Line 1):  Shipping Address (Line 2):  * Shipping City or Town:  * Shipping State/Province:  Alaska Alabama Arkansas Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming American Samoa Fed. States Of Micronesia Guam Marshall Islands Northern Mariana Islands Palau Puerto Rico Virgin Islands Alberta British Columbia Manitoba New Brunswick Newfoundland Northwest Territories Nova Scotia Ontario Prince Edward Island Quebec Saskatchewan Yukon * Shipping Zip / Postal Code:  * Shipping Address is: Select One Commercial Residential ($7.00 additional charge applies to residential shipping addresses; see shipping page) * Shipping Phone:  * Shipping Fax:  BILLING INFORMATION   Same as Shipping Address * Billing Name of Company: Billing Attention of: * Billing Address (Line 1):  Billing Address (Line 2):  * Billing City or Town:  * Billing State/Province:  Alaska Alabama Arkansas Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming American Samoa Fed. States Of Micronesia Guam Marshall Islands Northern Mariana Islands Palau Puerto Rico Virgin Islands Alberta British Columbia Manitoba New Brunswick Newfoundland Northwest Territories Nova Scotia Ontario Prince Edward Island Quebec Saskatchewan Yukon * Billing Zip / Postal Code:  * Billing Phone:  * Billing Fax:  ORDER INFORMATION Quantity of Bundles: (50 SpecTabs/bundle) x $40.00 Subtotal: $ Shipping Method: Select Shipping Method Regular Ground (3-5 business days) Two Day Air Next Day Air Shipping Cost: $ Sales Tax: $ Total Cost: $     Additional Comments :  You will receive an order confirmation email within two business days including the UPS tracking number. You will be able to track your order using our UPS Tracking area on our “Shipping Information” page. The above shipping charges are estimates. Actual charges may vary. All information given is for the sole use of Custom Inventory Systems and is not sold or shared with other companies or persons.