CN-383-I HVI Verification Cotton Order Form

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FORM APPROVED – OMB NO. 0581-0008

UNITED STATES DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SEVICE
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

HVI Verification Cotton Order Form
ITEM

STAPLE

HVI UHM
LENGTH in.

R1

30

0.93-0.95

R2

31

0.96-0.98

R3

32

0.99-1.01

R4

33

1.02-1.04

R5

34

1.05-1.07

R6

35

1.08-1.10

R7

36

1.11-1.13

R8

37

1.14-1.17

R9

38

1.18-1.20

DOLLAR
AMOUNT

QUANTITY
$

Totals:

$

Each HVI verification cotton comes with established values for length, uniformity index, strength and micronaire. Exact test values for each verification
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 X pound sample 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.
ACCT. NO.
EXPIRES
SIGNATURE
CHECK
VISA
MC
EXPORT

UNITED STATES
XXX.XX
………..….$XXX.XX
Surface Delivery
FOB Memphis…………..$

Request Quote for Air Freight Pre-Paid

SHIP TO (print or type )
CONTACT NAME

COMPANY NAME

STREET ADDRESS (necessary)
POSTAL BOX

CITY

PHONE

STATE, COUNTRY, AND ZIP CODE

E-MAIL ADDRESS

FAX

CN-393I 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 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 4 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.
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) 6329992. 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-393I Exp. X/XXXX) Destroy previous editions.