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Date:
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Name:
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Phone
Number: ___________________________________
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Company:
______________________________________________
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Account
Number: _________________________________
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Address:
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P.O.
Number:
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City:
________________________ State:
______ Zip: ___________
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Contact
Name: ___________________________________
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Special
Instructions:
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[
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Proceed with order.
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Please, send me a copy of your chemical catalog.
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[
] Quote
price & availability.
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[
] Call
me, I need assistance.
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Please, send me a copy of your dry bulk catalog.
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[
]
Please, add me to your mailing list.
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[
] Have
a salesperson contact me to open an account.
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Shipping
Information:
________________________________________________________________________________________________
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Customer
Information:
_______________________________________________________________________________________________
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Save this order form and copy for
easy ordering!
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Comments/Suggestions:_______________________________________________________________________________________________
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_________________________________________________________________________________________________________________ |
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_________________________________________________________________________________________________________________ |
Note: To be able to print this form on a
single page, under your browser's page setup or print settings, set your
top and bottom print margins to a minimal setting (usually somewhere between 0"
- .25"). Also, do not enable any header or footer options, such as
page number, date, URL, etc...
You can print and copy this form and fax it to us to place an
order, request a quote, catalog(s), more information or open an account. You
can also go to our convenient online Order/Quote
Form to be able to submit this form via the web or send us an e-mail at sales@ehlynn.com,
to accomplish the same purpose. Be sure to include your Name, Company Name, Complete Address, Phone Number, Fax
Number and E-mail
(if available), along with your request.
If you have any questions, please direct them
to
Chip Lynn at: (1-800) 633-2948, ext. 7111 or (1-815) 328-8811.
Thank you.
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