| Please print out this from, complete and faxed to 815-337-3020 Attn: sales Send my Resin Bins via the following freight carrier: |
| Your Carrier of Choice: ____________________________________________ Account # or Phone #________________________________________________ Ship via "Custom Carrier" - Freight Collect |
| Send my Soft Goods via the following method: |
| UPS freight collect Acct #: ______________________________________ Next Day (Red) Second Day (Blue) Third Day (Orange) FedEx Freight Collect Acct#:________________________________________ First Overnight Priority Overnight Standard Overnight 2Day Express Saver |
Contact Person: _____________________________________
On-line Order Number: ________________________________
Address: ___________________________________________
Address: ___________________________________________
City: _______________________ State: ____________ Zip: _______________
Phone: _____________________________ Fax: __________________________
E-mail Address: ____________________________________________________
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Date: ___________________