Order Form

Expanded Supply Products, Inc.

3330 Route 9

Cold Spring, NY 10516

Order Form

Please fill in the following form, print the form and mail or connect to the internet and click the SUBMIT button to forward your request.

Bill to:

Customer Name:

Address:

City, State, Zip:

Telephone #:Ext:

Fax#: eMail:

Web address:

Contact person:

Best time to call:

Purchase Order #: Date:

Ship To:

Customer Name:

Address:

City, State, Zip:

Special Instructions:

Product Number	Quantity	Unit	Description	Catalog Page	Unit Price	Total Price







shipping charges will be prepaid and added to invoice (unless delivered price has been quoted). Please call for estimated charges. * Shipping charges are taxable in NY. Please provide applicable tax exemption certificate with order.					Shipping Charges*
					Subtotal
					Sales Tax (if applicable)**
					Order Total

Billing Instructions/Account Information:

Established Open Account - Terms: Net 30 Days.

Account #

New Account-Immediate credit granted to municipal and private water and

wastewater utilities

Other, please complete and sign and submit a credit application

Check enclosed (US Funds only) Check #

Summary General sales terms: Prices subject to change and correction. All orders are FOB shipping point (unless delivered prices have been quoted) and will be shipped at the most efficient means available. Special ordered items may be non-returnable and non-cancelable. Limited warranties and liabilities apply. Please read our complete terms and conditions for details.

Authorized signature:

Printed Name:

Order Form

Please fill in the following form, print the form and mail or connect to the internet and click the SUBMIT button to forward your request.

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Last modified: July 24, 2013

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