Small Order Form

Please fill in this form completely

 

Cardholder Information

 

Card Information

  • Expiration Date

 

Order Information

 

Delivery Information

  • Order must be freight prepaid. Please provide your UPS account number. All orders will be sent by UPS Ground Service.
  • Please include street, city, state and ZIP code if information is different from billing address.
 

Signature

 

Verification

Small Order Policy

Jefferson Electric has instituted a Small Order Policy. Due to the expense of time and resources in processing,  orders under $100 must be paid by Credit Card. There will be a $25.00 or 3% charge (whichever is greater) for processing.

All orders must be freight prepaid. We will use your UPS account for ground delivery service. In cases where the item is located at a warehouse near  you, we can have your item ready for pickup within 3 working days.

Instructions

Please use either the form to the left or the fillable PDF to pay for your small order.

When you use the online form, please email your Purchase Order to us (custserv@jeffersonelectric.com) with a note that you have completed the form.

If you use the PDF, please email or fax both the completed PDF and your Purchase Order to us.

If you are ordering through your distributor, make sure that you include the PO number on all correspondence so we can match your payment to the order.

Let us know if you have any questions.

Email Customer Service

Telephone: 414-209-1620

Toll Free: 800-892-3755

 

DOWNLOAD FORM

If you prefer to download a PDF document to fill and send, click here.

Small Order Form

OUR INFORMATION

Jefferson Electric / Bemag

9650 South Franklin Drive

Franklin, WI 53132-8847

Email Customer Service

Customers from US and Canada should use the following telephone and FAX numbers:

Telephone: 414-209-1620

Toll Free: 800-892-3755

Fax: 414-209-1621

Toll Free Fax: 800-942-5169

Note: Division Headquarters is located in the Central Tim Zone and normal business hours are 8:00a.m. until 5:00p.m.

For a list of other departments, click here.

ABOUT US