Jeffreys, A Divsion of Phillips Corporation

Part Order Form

Order parts for one (1) machine only. Click here for the Haas Parts Pricelist.

If you need parts for more than one machine submit a seperate order for each machine. The same PO may be used on mutiple submissions.

All Fields Must be filled in to process your order!

Name:

Company Name:

Phone Number and Ext.:

E-mail:

Shipping Address:

City:

State:

Zip Code:

Machine/Model:

Serial#:

Customer PO#:

Enter Part Numbers
and/or Descriptions for required parts:

Qty

Replacement reason REQUIRED for parts with a core return. Reason example, Alarm or Fault codes:

How would you liked this order shipped?

UPS Ground

UPS 3 Day (Orange)

UPS 2nd Day (Blue)

UPS Next Day(Red)

UPS Next Day Early AM

Pick up when notified

Other: Please specify

*Please Note!*

Website part orders are processed Monday-Friday, between 8:00AM and 3:30PM Eastern Time. Orders received after 3:30PM will be processed on the next business day. If there is a problem with your order you will be notified by phone at the number you entered above. If any of the fields above are left blank this order will NOT be Processed. When your order is processed please specify below as to how you would liked to be notified. Use my Phone Number Above (A message will be left if no answer). Via E-mail Via Fax, Number:

How would you liked to be notified?

Use my Phone Number Above

Via E-mail

Via Fax