Hines Equipment Parts Order Form

6257 ADM. PEARY HWY.	CUSTOMER:
PO BOX 225	ADDRESS:
CRESSON, PA. 16630	TOWN:STATE:ZIP:
DATE:	PHONE #:
SHIP VIA: Pick UpOur TruckBest Way	E MAIL ADDRESS:
Payment Method: Case VantageMasterCard or VisaFarm PlanCash On Delivery   For Credit Card orders please contact us by phone with credit card information after submitting the form.

QUANTITY		PART NUMBER	DESCRIPTION (Model/Serial/VIN)	PRICE	EXTENDED
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• If Part Number is Unknown please entire the Model or Serial #/VIN in the Description field.
• Extended field is for multiples such as 3 blades or 10 plow shares