Wufoo

Enter Your Email Address *

This Email Address (Salesperson filling out the form) will be used to send an automatic receipt of this order to you.
Sales rep *
Alan Cordover Bill C. Billy P. Bruce M. Chas Chip Chris H. Chuck David N. Doug M. Glen Jeff S. Jim W. Joe C. John K. Mark Peter Rodney Scott H. Sean H. Steve B.

Please check your name on the list.
Date * MM / DD / YYYY
Customer Name *
Maximum Allowed: 82 characters. Currently Used: 0 characters.

Please enter customer name.
Customer Bill-To Address: *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country

Please enter complete address (all fields required).
Customer Ship-To Address: *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country

Please complete this field AS IT SHOULD APPEAR ON THE ORDER CONFIRMATION AND INVOICE!
Customer Contact Name * First Last
Contact name for order confirmation and invoicing. If another person is responsible for logistics, please indicate that in "other comments" below.
Customer email address: *

Please enter email address for customer contact for order confirmations and invoices.
Phone number for customer contact * ### - ### - ####
Please enter phone number for customer contact for order confirmation and invoicing.
Customer PO # *

Please enter customer purchase order number.
Material description for invoice *

Please enter description that should appear on order confirmation and invoice.
Material type *

Please check material type.
Please choose *
Prime Generic Prime Wide Spec

Please choose one.
Melt index *

Please enter melt index.
HLMI *

Please enter HLMI. If N/A, type either NA or -.
Density *

Please enter material density. If not applicable, please enter NA or -.
ETHY% *

Please enter value. If not applicable, please enter NA or -.
IZOD *

Please enter value. If not applicable, please enter NA or -.
HZ *

Please enter value. If not applicable, please enter NA or -.
ADDS *

Please enter value. If not applicable, please enter NA or -.
FM *

Please enter value. If not applicable, please enter NA or -.
MA% *

Please enter value. If not applicable, please enter NA or -.
VA% *

Please enter value. If not applicable, please enter NA or -.
AA% *

Please enter value. If not applicable, please enter NA or -.
Other material description

Please use this field for any other material descriptions or material information. Basically overflow from material description line above. No longer a required field.
Quantity ordered: *

Please enter quantity ordered.
Unit of measure: *
Pounds Metric tons KG Other (please define below)

Please check unit of measure for this order.
Price per U/M *

Please enter price quoted to customer.
Price is: *
Firm Subject to availability Other (please define below)

Please choose one option.
Packaging *
55.1 lb bags Cartons Super sacks Bulk Other (please define below)

Please check one.
FOB: *
Delivered Warehouse Other (please define below)

Please check one.
Railcar number (if known):

Please enter railcar number if known.
CAL Thermo lot number, if known:

Please enter CAL Thermoplastics lot number, if known.
Release number, if applicable:

Please enter release number, if applicable.
Expected SHIP date * MM / DD / YYYY
Please enter expected ship date.
Expected DELIVERY date * MM / DD / YYYY
Please enter customer delivery date.
Ship via: *
Best way Bulk truck CPU Drop ship Fed Ex Piggyback Railcar Sales rep Sea Title transfer Truck UPS Warehouse Other (please define below)

Please check one.
Payment terms quoted: *
Cash in advance COD Net 10 Net 30 Net 60 Wire transfer Against letter of credit Other (please define below)

Please check one.
Shipping instructions. *

Please be specific about any special instructions required.
Other comments:

If anything was marked "Other" above, please define here.
Commission sale:

If this is a commission sale, please enter commission percentage expected here.
Do Not Fill This Out