Customer Order Authorization

Please review your estimate information and complete this form to authorize your order.

You will also confirm your shipping instructions and payment method.

Customers paying by credit card will be redirected to Helcim’s secure payment page after submission. Customers paying by ACH or existing customer terms will not be redirected.

Need assistance?
(215) 551-6811
orders@phillycase.com

Order Summary

Please review the estimate information below before completing your order authorization.

Philly Case Estimate Number *

Customer / Company *

Estimate Total *

Estimated Shipping Charges

The estimate remains the controlling document for the products, quantities and pricing included in the order. Final freight charges may be added after the shipping method and delivery requirements are confirmed.

Questions about your order?

Please contact your Philly Case sales representative before authorizing the order, or contact us at
sales@phillycase.com
or (215) 551-6811.

1. Customer and Order Information

Customer Purchase Order Number

Company Name *

Customer Contact Name *

Email Address *

Telephone Number *

Upload Purchase Order (Optional)

You may also upload supporting documents related to this order. Accepted formats: PDF, Word, Excel or image files. Maximum file size: 10 MB.

2. Shipping Contact

Please provide the person Philly Case should contact when the order is ready for pickup, delivery or shipment.

Shipping Contact Name *

Shipping Contact Telephone *

Shipping Contact Email *

3. Shipping Method

How will the completed order leave Philly Case? *

LTL Freight Arrangements

Please tell us who will arrange the common-carrier shipment.

Who will arrange the freight? *

If Philly Case is arranging the freight, please provide the delivery address and receiving requirements below. If you or your carrier will arrange the freight, your Shipping Contact will be used to coordinate pickup when the order is ready.

Shipping Information

Ship-To Company *

Ship-To Street Address *

Suite, Building, Department or Attention

City *

State *

ZIP Code *

Country *

Receiving and Delivery Requirements

Is this a commercial delivery address?

Is a loading dock available?

Is a forklift available?

Will a liftgate be required?

Is inside delivery required?

Is a delivery appointment required?

Receiving Hours

Delivery and Receiving Instructions

UPS Parcel Shipping

Philly Case ships parcel orders using UPS. Please select how the UPS charges should be billed.

UPS Billing Method *

Customer UPS Account Number *

4. Payment Method

Please indicate how this order will be paid. Payment information is not entered directly into this form.

How will this order be paid? *

Credit card customers will be redirected to Philly Case's secure Helcim payment page after submitting this authorization. ACH payment instructions can be coordinated with Philly Case. Existing Customer Terms should only be selected by customers with established payment terms.

5. Additional Order Information

Is this order tax exempt?

Special Labeling, Documentation or Handling Requirements

Additional Instructions

6. Customer Authorization

I certify that I am authorized to place this order on behalf of the customer identified above and authorize Philly Case to proceed in accordance with the referenced estimate.

I understand that shipping or freight charges shown as “To Be Determined” are not included in the estimate total and may be added after the final shipping method and delivery requirements are confirmed.

I confirm that the order, shipping, receiving, payment method and delivery information provided in this form is accurate.

Name of Authorized Customer Representative *

Customer Initials *

Title

After submitting this form, credit card customers will continue to Helcim's secure payment page. Customers paying by ACH or existing terms will receive no payment redirect.