Taylor Preventive Maintenance Tune Up Kit Parts Program

taylor_logo
Credit Card Authorization Form | Taylor PM Parts Program Form


(For better print use landscape layout)

Please sign me up for the Preventive Maintenance “Tune Up Kit” Parts Program and automatically ship the items to me at the interval indicated below. I hereby authorize Taylor Equipment Distributors, Inc. to charge my credit card or my account for products or services as provided.

Model #: _____________________________________________________________________________

Serial #: _____________________________________________________________________________

  • ITEM :
  • QUANTITY :
  • FREQUENCY :
  • Tune Up Kit
  • __________
  • Quarterly
  • Scraper Blades
  • __________
  • Quarterly
  • Brush Kit
  • __________
  • Semi Annually
  • Taylor Lube
  • __________
  • Quarterly
  • Sanitizer
  • __________
  • Quarterly

Location/Business Name: ______________________________________________________________

Street: _____________________________________________________________________________

City: _______________________________________________________________________________

State: ______________________________________________________________________________

Zip Code: ___________________________________________________________________________

Telephone: ( ) ________________________________________________________________________

Fax: ( ) _____________________________________________________________________________

Email: ______________________________________________________________________________

Signature: __________________________________________________________________________

Date:  ______________________________________________________________________________

Printed Name: _______________________________________________________________________

Credit Card: ( ) VISA ( ) MasterCard ( ) Discover Expiration Date: ______________________________

Name on Credit Card: __________________________________________________________________

Credit Card Number: ___________________________________________________________________

Security Code: _______________________________________________________________________

Credit Card Billing Address (if different from above):

Street: _____________________________________________________________________________

City: _______________________________________________________________________________

State: ______________________________________________________________________________

Zip Code: ___________________________________________________________________________

Telephone: ( ) ________________________________________________________________________

Fax Credit Card Transaction Receipt to Fax Number: ( ) _____________________________________

Bill to my Account #: __________________________________________________________________

If you have any questions please contact the Parts Department at 301-773-2700.

PLEASE FAX THIS COMPLETED FORM TO 301-773-2720.