Bulk Tote Bag Request Form

Your Name
Your Email

QTY
Capacity	10-Lb. 20-Lb. 25-Lb. 50-Lb. 100-Lb. 25-Kg. 50-Kg.
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

Special Instructions:

IF ORDERING
Reference previous order #	(if any)
Purchase Order #
Where Billed

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

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