Product Requisition Order Form
Please use this form for submitting orders to Plum Rail
Date:
*
/
Month
/
Day
Year
Date of requisition
Customer's name:
Order submitted by:
*
First Name
Last Name
Your e-mail address:
*
example@chemjet.com
Customer's PO #:
As reference to this requisition
Order destination (city):
Product(s)
Product Requested:
*
Please Select
FLR
Gilsocol 100
Gilsocol DG
Gilsocol GP
Jet Black Gilsocol
Jet Trol Plus
Super G
Super G DG
Use the dropdown to select the product you're requesting
Customer's product name (aka):
Enter the customer's own private-branded name for the corresponding product
Package type:
*
Please Select
Supersac (bulk)
50 lb bag
55 lb bag (25kg)
25 lb bag
Quantity:
*
Enter total quantity of units required
Ready date request:
/
Month
/
Day
Year
Enter date the customer is requesting this material to be ready by
Additional comments as related to this requisition:
Submit Order
Should be Empty: