U.S. Irrigation Order Form

U.S. Irrigation order form

[One form per purchase order number; multiple Distributors can be chosen for each order. To Order By Phone 1-800-438-6071]
Date Ordered

Month Day Year
Requested Delivery Date

Month Day Year
Purchase Order Number
CUSTOMER SHIP TO ADDRESS
Contact
First Name / Last Name
Company Name
Shipping Address

Street Address

Street Address Line 2

City

Zip Code
State
Telephone
E-mail
CUSTOMER BILL TO ADDRESS
Contact
First Name / Last Name
Company Name
Billing Address

Street Address

Street Address Line 2

City

Zip Code
State
Telephone
E-mail
example@example.com
SELECT YOUR REP
- If the Ship-To State is AK, ID, MT, ND, OR, SD or WA, please select Craig Smith.
- If the Ship-To State is AZ, CA, CO, HI, KS, NE, NV, NM or UT, please select Nathan Hicks.
- If the Ship-to State is anything else, no selection is necessary.
Rep Selection
Servicing Distributor For This Order
"Servicing Distributors" are authorized UPL Aquatics Distributors with aquatic specialists trained in the use of UPL Aquatic Products. These "Servicing Distributors" serve as a partner to UPL in supporting our End-Users in the proper use of UPL Aquatic Products. Selecting a "Servicing Distributor" will give that company sales credit for this sale. Multiple selections can be made. If this does not apply, please select "None".
Servicing Distributor *

Cygnet Enterprises Helena Chemical NUTRIEN AG SOLUTIONS Simplot Partners Target Specialty Products VESERIS Wilbur Ellis Winfield united None
Product, Pack, Volume, & Price Information

Purchase Order Volume must be entered in volume quantities reflective of the pack size [i.e., 5 for the 2 X 2.5's / 125 for the 125s / and 250 for the 250s].


Product Name	Pack Size	Product Code	UNIT OF MEASURE	MINIMUM ORDER INCREMENTS	PALLET QUANTITY
CASCADE ^®	2 x 2.5 GAL	6020819	GAL	1 Pallet	180 GAL
CASCADE	250 GAL	6020167	GAL	250 GAL	250 GAL
TETON ^®	2 x 2.5 GAL	6020206	GAL	1 Pallet	180 GAL
TETON	125 GAL	6020359	GAL	125 GAL	125 GAL
TETON	250 GAL	6020212	GAL	250 GAL	250 GAL

CURRENT ^®	2 X 2.5 GAL	6020262	GAL	1 PALLET	180 GAL
CURRENT	250 GAL	6020261	GAL	250 GAL	250 GAL
SYMMETRY ^® NXG	2 X 2.5 GAL	6020288	GAL	1 PALLET	180 GAL
SYMMETRY NXG	250 GAL	6020343	GAL	250 GAL	250 GAL
TOP DECK™	2 X 2.5 GAL	6021594	GAL	1 PALLET	180 GAL
TOP DECK	250 GAL	6021680	GAL	250 GAL	250 GAL

Freight prepaid on pallet quantities only. Customer will be charged freight for all orders less than pallet quantities.

Cascade 2x2.5 GAL
Volume (gallons)
Cascade 250 GAL
Volume (gallons)
Teton 2x2.5 GAL
Volume (gallons)
Teton 125 GAL
Volume (gallons)
Teton 250 GAL
Volume (gallons)
Current 2x2.5 GAL
Volume (gallons)
Current 250 GAL
Volume (gallons)
Symmetry NXG 2x2.5 GAL
Volume (gallons)
Symmetry NXG 250 GAL
Volume (gallons)
Top Deck 2x2.5GAL
Volume (gallons)
Top Deck 250 GAL
Volume (gallons)
SPECIAL INSTRUCTIONS
Should be Empty:

U.S. Irrigation order form

CUSTOMER SHIP TO ADDRESS

CUSTOMER BILL TO ADDRESS

SELECT YOUR REP

Servicing Distributor For This Order

Product, Pack, Volume, & Price Information

SPECIAL INSTRUCTIONS