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4896 Order Form
 
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  Orderor Quote    
Bill To: Ship To:
Address: Address:
City: City:
State: State:
Zip: Zip:
Contact: Contact:
Email Email
Phone: Phone:
Your Name:  
Configuration:

Drive-up  Walk-up

  

Curb Height?

 
Enclosure Color Primary?

 (PMS Color Code)
Enclosure Color Secondary?

 (PMS Color Code)
Key locks the same?

yes no

 (One key fits both locks)
Standard ATM Decals?

yes no

  (3ea. 12" x 24")
Air Conditioner

yes no

  
Power Ingress?

Ref Dash 2000 PAD
Will ATM be shipped to DASH for install?

yes no

  
ATM Manufacturer?

 
ATM Model?

 

Options:

    
Video Security System?

yes no

  
Heater?

yes no

  
DASH installation?

yes no

 (Depends on location)
Palletize & Pack for shipping?

yes no

  
Who will arrange shipping?
(delivery 4-6 weeks)
DASH       You 		Dash assumes no liability for shipping damage incurred in transit. All freight claims must be handled directly with the common carrier (ABF). If you would like additional coverage, please advise and we will request a quote from ABF for you. (Inspect shipment when delivered)
Additional Instructions:

All sales are nonrefundable, due to the custom nature of the product.

                               

 
 

 
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