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SPX Service Solutions Vi s i t n i s s a n c o n s u l t . s p x . c o m

Dealership Code Dealership Contact SOLD TO Name: ATTN: Street Address: City State/Province: Tel. No. Fax No. SHIP TO Name: ATTN: Street Address: City: State/Province: Tel. No. Zip/Postal: Please Contact Me Phone: LEASE TERMS DESIRED (months): Name as it appears on credit card: Zip/Postal: Acct. No. Last 3 digits of Security Code (on back of card) Exp. Visa American Express MasterCard Discover NET 30 - Open Account No. Date: PAYMENT PLAN

QTY

PART NUMBER J-50751 J-47446-VI2-B J-47446-CART J-47446-PRNT J-47446-WAR

DESCRIPTION CONSULT Kit CONSULT-III plus Kit Cart with Locking Docking Station Wireless Printer HP1022NW with Cable Extended 5-Year Warranty* **PLEASE CALL 1-800-662-2001 FOR CURRENT PRICES

**UNIT PRICE

AMOUNT

*Extended Warranty must be purchased within 30 days of the shipment of your CONSULT III Kit. A support fee will be charged on all CONSULT orders. Dealer Name (please print) _______________________________________________________ Authorized Dealer Signature______________________________________ Date____________ Authorized Dealer Equipment Signature_____________________________ Date____________ ALL SALES ARE FOB SHIPPING POINT. By signing above Dealer accepts all terms and conditions of sale, which are contained within the Program catalog.

Sub Total Estimated Freight Estimated Install. Taxes TOTAL

Please Print & Fax this form to : 1-800-578-7375 Outside U.S. and Canada: 1-507-455-7063 Visit nissantechmate.spx.com for your Special Service Tools.

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