HWH Corporation
2096 Moscow Rd | Moscow IA 52760
Ph:
563-724-3396 | Fax: 563-724-3408
Email: sales@hwh.com | Web: www.hwh.com
HWH Order:
Order Date:
HWH Customer #:
Fields highlighted in red are required.
Contact Phone #:
Customer Email:
Ship To:
ORDER FORM
Customer PO Number
Bill To:
Leave
blank if same as
Ship To:
Shipping Method
If other, specify:
Part Number & Description
Qty Used
Unit Price
Extended Amount
Tax:
Total:
Coach Owner Information
Coach & System Information
Name:
VIN:
Phone:
Serial Number:
Address1:
Purchase Date - Coach:
Address2:
Purchase Date - System:
City:
Coach Make:
State/Province:
Zipcode:
Coach Year:
Country:
Coach Model:
Coach Owner & Coach Information is helpful in verifying that you have ordered the correct parts.

Non U.S. Transactions:
If this transaction involves a non-U.S. party ("Ship-To" and/or "Bill-To") this section must be filled out, or we cannot process the order. (As a U.S. Exporter, we are legally required to obtain the following End-Use information to determine if an export license is required.)

What is the END USE of the goods being ordered?

Chemical & Biological Weapons Regional Stability
Fireams Conventions Nuclear Nonproliferation
Crime Control National Security
Anti-Terrorism Missile Tech
Other (explain):

I would like to see an Order Acknowledgement, with pricing, before you process my order.

An Order Acknowledgement containing part-price & estimated shipping cost will be sent to the email address above.
Order will be held (for four weeks) awaiting approval referencing the Order Number.
If you do not have credit you will be contacted by phone to arrange payment.

I do NOT need to see an Order Acknowledgement. Please process my order immediately.