Form CN-383-H International Calibration Cotton Standard Order Form

REPRODUCE LOCALLY

FORM APPROVED – OMB NO. 0581-0008

UNITED STATES DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE
COTTON AND TOBACCO PROGRAM
DATE:

ORDER #
DO NOT WRITE IN THIS SPACE

Standardization & Engineering Division
3275 Appling Rd.
Memphis, TN 38133
Telephone: (901) 384-3030
Fax: (901) 384-3032
E-mail: [email protected]

PAID BY CHECK NO.

AMOUNT

RECEIVED BY

DATE

International Calibration Cotton Standard Order Form
Stelometer
DESCRIPTION

ITEM

1/8" Gage

Elongation

Grams/Tex

(Percent)

E3

C - XX

American Upland

XX.X

X.X

E11

L-X

American Upland

XX.X

X.X

E12

M-X

American Pima

XX.X

X.X

Fibrograph
2.5%

50%

DOLLAR
AMOUNT

Micronaire QUANTITY

Span Length, in. Span Length, in.

X.XX

X.XX

X.XX

$

TOTALS

$

Check Here To Be Included in the Semi-Annual ICCS Check Test
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 blended card web.
PRICES: The price of each 1/2 pound sample includes packaging, handling and delivery where stated. Fumigation (if needed) is a minimum
of $X.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

UNITED STATES
FOB Memphis...
Surface Delivered...

SIGNATURE
EXPORT

$XX.XX
$XX.XX

Request Quote for Air Freight Pre-Paid

SHIP TO (print or type)
CONTACT NAME

COMPANY NAME

STREET ADDRESSS (necessary)

POSTAL BOX

CITY

PHONE

STATE, COUNTRY, AND ZIP CODE

E-MAIL ADDRESS

FAX

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 unless it
displays a valid OMB control number. The valid OMB control number for this information collection is 0581-0008. The time required to complete this information
collection is estimated to average 3 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data
needed, and completing and reviewing the collection of information.

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

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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) 8778339. 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. 202509410; (2) fax: (202) 690-7442; or (3) email: [email protected].
USDA is
an equal opportunity provider, employer, and lender.

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