Arctic Snow and Ice Products

Pusher Order Form

Salesman Code (You cannot submit the form without it.)

Is this a CNH order?

Customer Information

Customer #

Company Name

Address

Address Line 2

City

State

Zip

Country

Attention

Phone

Fax

Check if customer info is the same as shipping info.

Shipping Information

Customer #

Company Name

Address

Address Line 2

City

State

Zip

Country

Attention

Phone

Fax

Order Taken By

Date

P.O. #

Terms

Ordered By

Ship Via

Discount Level

Order Information

Pusher Model#

Qty.

List Price

Dealer Price

Amount

Coupler#

Qty.

List Price

Dealer Price

Amount

Special Notes

Pre Sub-total (Pushers/Plows) Before Discounts

Additional Early Order Discount (%)

Sub-total (Pushers/Plows)

Sub-total (Couplers)

Sub-Total (Pushers and Couplers)

Early Payment Discount (%)

Grand Total

CNH Vendor Code: DV6ARTC1	CNH Promotion Code USA: BVK67
CNH Contractor Code: 6BVK67	CNH Promotion Code Canada: DV6ARTCA