Vendor Name*

Purchase Order Number *

Please use todays date if you do not use a PO tracking system.

Name of person placing PO *

Email Address *

Billing Address

Address One *

Address Two

City *

State *

Zip *

Shipping Address
Check this box to use billing address.
Address One *

Address Two

City *

State *

Zip *
Remember to specify finish and Each or Pair when applicable in the Model Number field.

QuantityModel Number
* Required

Additional Notes/requests

Digital Sales Group, Inc.
9555 Alden Road
Lenexa, Kansas, 66215

Tel: 913-495-2515 Fax: 913-495-2519

Digital Sales Group, Inc.
241 Chesterfield Industrial Road
Chesterfield, Missouri, 63005

Tel: 636-536-1501