Poly Pak Plastics - Submit an Order

If you're interested in information on more than one product, fill out this form,
click the "submit" button to submit it,
press the "reset" button and refill out information and resubmit it.

And, as always, if you don't want to deal with this form,
please just call us and we'll be glad to talk with you about a quote over the phone.
We WANT to talk with you!
You can also click here to go to our ORDER FORM form.

CUSTOMER INFORMATION:

Name:

Title

Company Name:

Street Address:

City:

State

Zipcode

Phone Number:

Fax Number:

Email:

Contact me via:

SHIPPING INFORMATION:

Shipping information is same as customer information (if checked, skip this section)

Street Address:

City:

State

Zipcode

SALES INSTRUCTIONS :

P.O. #:

Date
Required:

Special Instructions:

Terms Desired:

Our standard terms are 1% 10 net 30.
* To optain our open account, we will require 3 trade references and one bank reference. Fax a credit form to (800) 808-8660

PRODUCT DESIRED:

Other:

Size: Width: Length: Mil Thickness: Other:

Quantity: Other:

MISC:

Ship Via:

Instructions:

Truck Company, UPS #, etc.

Please with any questions.

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