Your Name
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QTY
Capacity	2,000-Lb. 2,200-Lb. 3,000-Lb. 4,000-Lb. 4,200-Lb. Other (See Spec. Inst.)
Bag Size
Safety Factor	5-to-1 6-to-1   Style  Circular U-Panel
Fill-Type	Duffel Spout (14"D x 18"L) Spout (specify size) Open top
Discharge-type	Spouted (14x18) tuck-in w/outer tied closure Specify other in "Special Instructions"
Commodity

 

 

 

If ordering
Reference previous order #	(if any)
Purchase Order #
Where Billed

 

 

 

 

 

DELIVERY			Ship to:  Address
When needed?		Company
Month:	Jan Feb March April May June July Aug Sep Oct Nov Dec	Street
Time of Month:	1st week 2nd Week 3rd Week 4th Week	City	State or prov.
		Postal Code	Country

 

 

 

 

 

 

 

 

Special Instructions:

 

 

 

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After receipt of your request, we will contact you with follow-up information or order confirmation.  Thanks again!