## Web form to create Order Status

Submitting this form will create Order Status

Description:
Salutation:
Company Name:
Name: *
TAG:
Order Number:
Do Not Call:
Phone:
Mobile:
Office Phone:
Other Phone:
Fax:
Email Address:
Other Email:
Lawful Basis:
Lawful Basis Date Reviewed:
Lawful Basis Source:
Primary Address Street:
Primary Address City:
Primary Address State:
Primary Address Postalcode:
Primary Address Country:
Alt Address Street:
Alt Address City:
Alt Address State:
Alt Address Postalcode:
Alt Address Country:
Assistant:
Assistant Phone:
Referred By:
Order Status Source:
Order Status Source Description:
Upholstery Status:
Status Description:
Account Name:
Lead Description:
Welding Inventory Name:
Welding Inventory Amount:
Birthdate:
Portal Name:
Portal Application:
Website:
Chair or Parts?: *
Sales Representative:
Footrest and Foot Plates:
Colour:
Wheel Lock:
Special Instructions:
Rear Wheel:
Built by:
Built by: *
ETA Date:
Serial Number:
Headrest:
Client Weight:
STF:
Arm Rest:
Shipper:
expected to ship by:
Address:
Ship Tracking #:
Frame Colour:
Caster:
Assembly Status: *
Seat Depth:
Back Height:
Seat Width:
Seating Cushions:
P.O Number:
Geocode Status:
Dealer Name:
ETA Change Reason:
Notes:
Type:
Priority:
Company:
Back Type:
Accessories:
QC by:
Size:
Inside Mount:
Seating Backs:
ETA: *
Upholestery Box Number:
Email Address:
Hold Notes: