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First Name:*    Last Name:*
Title:
Company Name:*
Shipping Address:*
   Address (cont'd):
City:* State:* Zip Code:*
Country:
Phone Number: *      Fax Number:
E-mail Address:*
Order Quantity:*
Annual Qty:
Your Product:* [?]
Dimensions:
Length*   Width*   Height*    inches cm
Type of Strap:* 
Safe Working Load :*  (in pounds)
Type of Material:*
Coated Uncoated Conductive Antistat
Other Material
Type of Fill Spout:* 
Fill Spout Closure: 
Type of Discharge Spout:* 

Discharge Cover: 
Discharge Closure: 
Web Tie  Wire Tie  Std. Cordlock  HD Cordlock
Other Discharge Closure
Options:
Sift Resistant Construction   Reinforcement around the top (R.A.T.)

Other Option(s):
Document Pouch:Yes  No
U.N. Packaging: Required if U.N. construction.

U.N. #  [?]
Liner:
None  1.5 mil  3.0 mil  6.0 mil   Other
Additional Comments: