Supply Order form

[Pages:1]* Required Field

Supply Order Form

*Name: ___________________________________________ Title: ____________________________________________ *Company Name: ________________________________________________ *Address(line 1): _______________________________________ Address(line 2): ______________________________________ *City: ________________________________________ *State: ____________ *Country __________________________ *Zip code/postcode: ______________ Phone: _______________________________ Fax: _______________________________

Email: _________________________________________________________

Soil Supplies Qty. _____ Qty. _____ Qty. _____ Qty. _____

Soil Sample Bags Soil Information Sheets(to return with samples Preprinted Mailing Return Labels UPS Prepaid Return Labels

Plant Tissue Supplies Qty. _____ Tissue Sample Bags Qty. _____ Tissue Information Sheets(to return with samples Qty. _____ Preprinted Mailing Return Labels Qty. _____ UPS Prepaid Return Labels

Water Testing (irrigation water) Qty. _____ Water Testing bottles Qty. _____ Water Information Sheets(to return with samples Qty. _____ Preprinted Mailing Return Labels Qty. _____ UPS Prepaid Return Labels

Greenhouse "artificial growth media" Qty. _____ Soil Sample Bags Qty. _____ Media Information Sheets(to return with samples Qty. _____ Preprinted Mailing Return Labels Qty. _____ UPS Prepaid Return Labels

Miscellaneous Supplies Qty. _____ Large Shipping Boxes (holds 20 soil samples) Qty. _____ Small Shipping Boxes (holds 10 soil samples) Qty. _____ Sampling Procedures for Soil Qty. _____ Sampling Procedures for Plant Tissue Qty. _____ Sampling Procedures for Irrigation Water Qty. _____ Soil Importation Labels (necessary for foreign shipments)

Fax to: (402) 476-0302

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