Invoice

Fill in the following form to submit an invoice to Pacific Specialty Brands for the Faber, Fulgor Milano, Fagor, Blomberg. Click the "Submit" button when the form is completed. Please use the date format of MM-DD-YYYY for any dates.

All fields are required.

Customer Information
First Name:
Last Name:
Street Address:
City:
Province/State:
Postal/Zip Code:
Country:
Primary Phone Number:
Secondary Number (not required):
Customer Complaint:
Brand Information
Brand Name:
Model Number:
Serial Number:
Purchase Date (MM-DD-YYYY):
Dealer Name:
Service Information
Date Call Was Received:
Date Started (MM-DD-YYYY):
Date Completed (MM-DD-YYYY):
Charge Time:
Explanation of Service Performed and/or Comments:
Service Company:
Service Address:
Service Company Invoice #:
Technician Name:
Service Company Phone:
Service Company E-Mail:
(a copy of this invoice will go to this e-mail)
Quantity PSB Inv. # Part No. Part Description Amount
Total Parts
Service Call
Total Labour
Canadian GST
Canadian HST
TOTAL

     

Pacific Specialty Brands | 7595 Lowland Dr. Burnaby, BC V5J 5L1 Canada | Tel: 604-430-5253 Fax: 604-434-4225
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