CN-383-K Micronaire Orifice Calibration Material 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

Micronaire Orifice Calibration Material Order Form
ITEM

U.S.

Micronaire Orifice Set

J1

Storage Box, 10 gram brass weight, and
Low & High Orifice Plugs

J2

Low Micronaire Orifice Plug

J3

High Micronaire Orifice Plug

J4

Reassignment of Micronaire Orifice Set
(Requires the return of orifice set)

Micronaire Orifice Storage Box

J5
S1

Includes 10 gram brass weight

Micronaire Chamber Calibration Cotton
(5 lbs.)

EXPORT

FOB Memphis

$XXX.XX

Surface Delivery

$XXX.XX

FOB Memphis

$XX.XX

Surface Delivery

$XX.XX

FOB Memphis

$XX.XX

Surface Delivery

$XX.XX

FOB Memphis

$XX.XX

Surface Delivery

$XX.XX

FOB Memphis

$XX.XX

Surface Delivery

$XX.XX

FOB Memphis

$XX.XX

Surface Delivery

QUANTITY

Request Quote for
Air Freight Pre-Paid

DOLLAR
AMOUNT
$

Request Quote for
Air Freight Pre-Paid
Request Quote for
Air Freight Pre-Paid
Request Quote for
Air Freight Pre-Paid
Request Quote for
Air Freight Pre-Paid
Request Quote for
Air Freight Pre-Paid

$XXX.XX

Totals

$

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

SIGNATURE

PRICES: Price of standards 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.

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

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