PURCHASE ORDER FORM Cash, Certified

Check, Money
Order or
Credit card
Date ORDER No. Estimated Delivery Sales Rep. Sales Rep ID COD
Date No Personal
Checks
Buyer(s) Name
Deliver To:
Name____________________________
Buyer(s) Address
Address__________________________
Buyer(s) City Zip _
Code
City______________________________
Buyer(s) Phone
Phone____________________________

Area Product Description Cash Price

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TAX

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If at the time of installation it is determined that additional repairs are TOTAL
needed to perform the scope of work listed above charges will be required.

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Estimated Start Date / / Estimated Completion Date / DEPOSI

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/ T
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BALAN
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BUYER’S RIGHT TO CANCEL: if this agreement was solicited at or near your residence andCE you do not want the
goods or services cancel this agreement by mailing a notice to the seller saying you do not want the goods or
services. This notice must be mailed to BroCAR Service and Repair, LLC 9500 Silver Fox Turn Clinton, MD
20735. If you cancel, the seller may not keep any of your down payments. Do not sign this contract in blank.
You are entitled to a copy of this contract at the time you sign it. This Agreement front and back, constitutes
the ENTIRE understanding between BroCAR and the undersigned (BUYER) and there are no verbal
understandings. Buyer(s) hereby acknowledge that they have read the front and back of this Agreement and
has received a completed, signed and dated copy of this Agreement. Buyer(s) also acknowledges that they
were orally informed of there right to cancel this agreement. BroCAR Service and repair, LLC.

Accepted by:_____________________________________ Accepted by:_____________________________________ Accepted

By:_____________________________________
Buyer(print name) Buyer(print name) BroCAR Representative

Accepted by:_____________________________________ Accepted by:_____________________________________ Accepted

You, the Buyer(s), may cancel this transaction at any time prior to midnight of the third
By:_____________________________________
Buyer Signatureday after the date of this
business Buyertransaction.
Signature See the attached notice
BroCAR of cancelation
Representative Signature

for as an explanation to this right.