Ordering Loaded PCB Test Products

Ordering Loaded PCB Test Fixtures

Use this form to place an order.

To order product:

If you currently have an account with Everett Charles Technologies, and ECT has the correct Ship-to-Information on file, plese enter your full name and company in Section 1 and then skip to Section 3 and Section 4.

If you do not have an ECT account, please fill out Section 1 and Section 2 completely, then go to Section 4.

Section 1: Contact Information

Full Name:

Title:

Company:

Postal Address:

City, State and Zip:

Country:

Telephone:

Facsimile:

Email:

Section 2: Shipping Information

Please enter the shipping information only if it differs from the above information.

Ship-To Name:

Company:

Postal Address:

City, State and Zip:

Country:

Telephone at Address:

If you DO NOT have an ECT account, skip to Section 4.

Section 3: Payment Information

ECT has two methods for placing orders:

Method 1:
Established Account:

If you currently have an account with ECT, specify both your customer number and a purchase order number.

Method 2:
Credit Card

Specify that the order will be charged to a credit card, and a representative from ECT will contact you to obtain the cardholder information.

Payment Type:

Established Account Credit Card

P.O. Number:

Customer Number:

Date Needed:

Ship Via:

Ship Via Other:

Section 4: Product Ordering

Enter the quantity and part numbers. Add any special requirements or needs under "Notes."

Item	Qty.	Part Number	Notes
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1
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4
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7
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Section 5: Information Review

Please take a moment to review the information you have provided above. If it is correct, please press the SUBMIT button below. Otherwise, please correct the information before submitting. If you would like to have all completed information cleared, press the CLEAR button below.