Customer       Date Received:  Address1       Sales Rep.:  Address2     City              State    --- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Mississippi Minnesota Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming   Zip     Buyers Name:   Telephone: (  )   -   P.O. No.:       DELIVERY DATE:     January February March April May June July August September October November December   1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   2004 2005 2006 2007 2008 2009 REC. SHIP DATE:     January February March April May June July August September October November December   1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   2004 2005 2006 2007 2008 2009 SHIP TO: QUANTITY COLOR No. COLOR RATIO LOT No. PRICE SPECIAL INSTRUCTIONS: SELECT ITEMS WHICH MUST BE PROVIDED WITH SHIPMENT:       PACKAGING: GAYLORDS     DRUMS     BOXES           CERTIFICATE OF ANALYSIS        CERTIFICATE OF COMPLIANCE          MSDS          PRE-SHIP SAMPLE