Case Priority:
Creation Date: Tuesday, October 04, 2022
Creation Time: 9:47:51 PM
Case/P.O. Number:
D.N.E. (Do Not Exceed Amount):

Case Ordered By:    
Company With:  
Office Phone Number:  
Cell Phone Number:  
Fax Number:

Bill To:
Bill To Address:
Bill To City:
Bill To State:
Bill To Zip Code:

Store Name:
Store Number:
Store Address:
Store City:
Store State:
Store Zip Code:
Store Phone Number:
Store Contact:

Problem Description 1:
Problem Description 2:
Problem Description 3:
Problem Description 4:
Problem Description 5:


Please type the color of the third character: