Product Order Form
Bio Soil Enhancers, Inc. 1161 James Street Hattiesburg, MS 39401
Phone: (601) 582-­‐4000 Fax: (601) 582-­‐4100 Email: [email protected]
Date PO # Ship To ☐ Same as Bill To Bill To Licensee Company Name Name Address 1 Address 1 Address 2 Address 2 City City State/Other State/Other Postal Code Postal Code Country Country Email Email Phone Phone Payment Method ☐ Parcel Shipment ☐ Freight Shipment ☐ Charge Card on File ☐ FedEx Acct# Company ☐ Call for Payment ☐ UPS Acct# Contact ☐ Prepaid Account Billing Postal Code Phone Other ☐ Other Product Name (Label & Formula) ☐ Distributor label – Contact info to be included on label if different from licensee ☐ More than one product is being ordered; continue on additional page(s). Container Total Price Per Container Size Type Gallons/Liters Gallon/Liter ½ Gallon / 2 Liter
Jug
2 Gallon / 7.5 Liter
Jug
25 Gallon / 94.6 Liter
Drum
50 Gallon / 189 Liter
Drum
250 Gallon / 946 Liter
Tote
Other
Additional Comments
Quantity Containers Price Per Container Total Subtotal
Other Pages
Total
THIS PRODUCT IS INTENDED FOR USE IN _____________________
Quality Control
Order #
Formula: Gen Ag / Forage / Other
V 3.3
# of Boxes / Pallets
Weight
Dimensions
Updated 10/22/2015
Product Order Form
Bio Soil Enhancers, Inc. 1161 James Street Hattiesburg, MS 39401
Date Phone: (601) 582-­‐4000 Fax: (601) 582-­‐4100 Email: [email protected]
PO # Page ____ of ____
Completed By
Date
Finished Batch #
pH
Humic Batch #
☐ Multiple Formulas or Batches (additional info on back of page)
Product Name (Label & Formula) ☐ Distributor label – Contact info to be included on label if different from licensee Container Size Container Type ½ Gallon / 2 Liter
Jug
2 Gallon / 7.5 Liter
Jug
25 Gallon / 94.6 Liter
Drum
50 Gallon / 189 Liter
Drum
250 Gallon / 946 Liter
Tote
Total Gallons/Liters Price Per Gallon/Liter Quantity Containers Price Per Container Total Other
Subtotal
Product Name (Label & Formula) ☐ Distributor label – Contact info to be included on label if different from licensee Container Size Container Type ½ Gallon / 2 Liter
Jug
2 Gallon / 7.5 Liter
Jug
25 Gallon / 94.6 Liter
Drum
50 Gallon / 189 Liter
Drum
250 Gallon / 946 Liter
Tote
Total Gallons/Liters Price Per Gallon/Liter Quantity Containers Price Per Container Total Other
Subtotal
Product Name (Label & Formula) ☐ Distributor label – Contact info to be included on label if different from licensee Container Size Container Type ½ Gallon / 2 Liter
Jug
2 Gallon / 7.5 Liter
Jug
25 Gallon / 94.6 Liter
Drum
50 Gallon / 189 Liter
Drum
250 Gallon / 946 Liter
Tote
Other
Total Gallons/Liters Price Per Gallon/Liter Quantity Containers Price Per Container Total Product Order Form
Bio Soil Enhancers, Inc. 1161 James Street Hattiesburg, MS 39401
Phone: (601) 582-­‐4000 Fax: (601) 582-­‐4100 Email: [email protected]
Date PO # Page ____ of ____
Subtotal