CN-383-C Micronaire Cotton Standards Order Form

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FORM APPROVED – OMB NO. 0581-0008

UNITED STATES DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE
COTTON AND TOBACCO PROGRAM
DATE
Standardization & Engineering Division
3275 Appling Rd.
Memphis, TN 38133
Telephone: (901) 384-3030
Fax: (901) 384-3032
E-Mail: [email protected]

ORDER #

DO NOT WRITE IN THIS SPACE
PAID BY CHECK NO.

AMOUNT

RECEIVED BY

DATE

Micronaire Cotton Standards Order Form
Universal HVI Micronaire Calibration Cotton Standards
DESCRIPTION

MICRONAIRE
READING

Au

American Upland

~5.5

Gu

American Upland

~2.6

ITEM

U1
U2

DOLLAR
AMOUNT

QUANTITY
$

Micronaire Only International Calibration Cotton Standards
DESCRIPTION

MICRONAIRE
READING

Am

American Upland

~5.5

Bm

American Upland

~4.5

Cm

American Upland

~3.5

Dm

American Upland

~4.0

Gm

American Upland

~2.6

Im

American Upland

~5.0

ITEM

F1
F2
F3
F4
F5
F6

DOLLAR
AMOUNT

QUANTITY

TOTALS

$

Exact test values for each calibration cotton are shown on the label of each sample. These values are established by designated laboratories.
The samples are raw cotton.
PRICES: The price of each one pound standard includes packaging, handling and delivery where stated. Fumigation (if needed) is a minimum of
$XX.XX per order. Phytosanitary Certificate (if needed) is $XX.XX.
PAYMENT MUST BE SUBMITTED WITH ORDER. WE DO NOT ACCEPT LETTERS OF CREDIT.
CHECK MUST BE DRAWN ON A U.S. BANK PAYABLE TO: USDA, AMS, COTTON AND TOBACCO PROGRAM.
CHECK

VISA

MC

ACCT. NO.

EXPIRES

EXPORT

UNITED STATES
FOB Memphis ……….…………..……….$XX.XX
Surface Delivered

SIGNATURE

…………....………….$XX.XX
SHIP TO (print or type)

CONTACT NAME

Request Quote for Air Freight Pre-Paid

COMPANY NAME

STREET ADDRESS (necessary)
POSTAL BOX

CITY

PHONE

STATE, COUNTRY, AND ZIP CODE

E-MAIL ADDRESS

FAX

CN-383C (Exp. X/XXXX) Destroy previous editions.

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information
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maintaining the data needed, and completing and reviewing the collection of information.
In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and
employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, religion, sex,
gender identity (including gender expression), sexual orientation, disability, age, marital status, family/parental status, income derived from a public assistance
program, political beliefs, or reprisal or retaliation for prior civil rights activity, in any program or activity conducted or funded by USDA (not all bases apply to all
programs). Remedies and complaint filing deadlines vary by program or incident.
Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large print, audiotape, American Sign Language, etc.)
should contact the responsible Agency or USDA’s TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA through the Federal Relay Service at (800)
877-8339. Additionally, program information may be made available in languages other than English. To file a program discrimination complaint, complete the
USDA Program Discrimination Complaint Form, AD-3027, found online at http://www.ascr.usda.gov/complaint_filing_cust.html and at any USDA office or write a
letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit
your completed form or letter to USDA by: (1) mail: U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights 1400 Independence Avenue,
SW Washington, D.C. 20250-9410; (2) fax: (202) 690-7442; or (3) email: [email protected].
USDA is an equal opportunity provider, employer, and lender.

CN-383C (Exp. X/XXXX) Destroy previous editions.