Order Form

Project Name*
Company*
Project Address*
Street Address City State / Province / Region ZIP / Postal Code Country
What is being attached?*
- Solar
- HVAC Equipment
- Safety / Security Equipment
- Snow Retention
- Electrical / Lighting
- Other
Solar Project Size (KW/MW)
Which solar racking manufacturer?
Who is the HVAC equipment manufacturer?
Who is the Safety / Security equipment manufacturer?
Who is the Snow Retention equipment manufacturer?
Who is the Electrical / Lighting equipment manufacturer?
Please specify 'Other':
Who is the 'other' equipment manufacturer?

Where will this ship?*
Shipping Address
Street Address City State / Province / Region ZIP / Postal Code Country
Primary POC Name*
First Last
Primary POC Company*
Primary POC Job Title*
Primary POC Phone*
Primary POC Email*
Requested delivery date*
Date Format: MM slash DD slash YYYY
Preferred shipping method*

Where will this be billed?*
Billing Address
Street Address City State / Province / Region ZIP / Postal Code Country
Accounts Receivable POC Name*
First Last
Accounts Receivable POC Job Title*
Accounts Receivable POC Company*
Accounts Receivable POC Phone*
Accounts Receivable POC Email*
Preferred Invoice Method*
By acceptance of any proposal, issuance of any order and/or payment of any invoice, the customer acknowledges and warrants that all statements or suggestions by Anchor Products or its affiliates of any type, amount, use or placement of products for customer’s projects is exclusively based on information provided by the customer. Customer waives all claims against Anchor Products or its affiliates related to or based on inaccuracies in the data provided by the customer. Customer further confirms it has not relied on Anchor Products or its affiliates for any engineering advice or conclusions.
Name
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