| |
| FULL NAME |
|
| TITLE |
|
| COMPANY |
|
| TELEPHONE |
|
| FAX |
|
| DIRECT LINE OR EXTENSION |
|
| E. MAIL |
|
| IDENTIFICATION CODE |
|
| If no ID code, ENTER COMPANY
NAME |
|
| COMPANY ADDRESS |
|
| COUNTRY |
|
| PURCHASE ORDER NUMBER, if firm order |
|
IF
COMPANY ACCOUNT, ENTER ACCOUNT # |
|
| METHOD OF PAYMENT |
CHECK/MONEY
ORDERLETTER OF CREDIT
TERM PAYMENT
COMPANY ACCOUNT
|
| TYPE OF PURCHASE |
FOR
RESALE
FOR COMPANY USE
|
| IS THIS A;
|
PRICE
REQUEST FIRM ORDER |
| SHIPMENT |
F.O.B.
C.I.F.
|
| SHIP TO; |
|
| Product (s) |
|
| PLEASE SPECIFY API GRADE AND/OR OTHER
CLASSIFICATION |
|
| TYPE OF PACKAGING |
|
| SPECIAL INSTRUCTIONS, COMMENTS AND SUGGESTIONS: |
|
| WOULD YOU LIKE TO BE CONTACTED
BY OUR AGENT IN YOUR REGION ? |
|
| WOULD YOU LIKE TO RECEIVE COMPANY NEWS LETTER .
? |
|
| IF YOU HAVE USED OUR PRODUCTS
BEFORE, HOW WOULD YOU RATE THE QUALITY OF THE SERVICE PROVIDED BY OUR SALES DEPT. |
|
| IF THIS IS YOUR FIRST VISIT WITH US, PLEASE TELL
US, HOW DID YOU HEAR ABOUT OUR COMPANY ? |
|
|
|
