Delta Foremost Chemical Corp. Order Form


Salesperson Name	Salesperson Number	Salesperson Email	Customer Phone Number

Buyer Email (Order Copy)	Invoice Y/N	Accounts Payable Email (Invoice Copy)	Same as Buyer

Company Name & Shipping Address
Company Name	Attention: (First & Last Name)

Street Address	City	State	Zip

Billing Address (Same as shipping address unless specified)
Company Name	Attention:

Street Address	City	State	Zip

Shipping Details / Purchase Order
Order Date	Shipping Date	Purchase Order Number	Route	Freight Terms

Product Order(s)
Product Name	Product Number

Quantity	Size	Unit	Pack	Price	Extension

Special Instructions
Please leave any additional notes here

Optional Email CC

Credit References
Is this an approved national account?	Yes	No
Is account on leads site?	Yes	No
Are we selling other locations?	Yes	No
If yes, where?

References To Setup Open Billing
Bank	City	State	PO Required?
			Yes	No

Open Billing Vendors --- No COD Vendors
Name	Vendor Account #	Phone #

Email Address	City	State	Zip

Delta Foremost No Nonsense Guarantee!

On initial orders, Foremost products are subject to a trial period, for 30 days from date of invoice. Should the merchandise not prove satisfactory within this time period, simply notify our home office, for authorization to return. Your cost will be limited only to the amount of merchandise actually used, and return freight. No credit will be allowed on contaminated products. Equipment is supported by the manufacturer's warranty and is not included in this guarantee. No other guarantee, either expressed or implied, will apply to merchandise covered by this order. No products are consigned, but are invoiced when shipped, subject to above.

Terms & Conditions Verbal

* Customer agrees to pay a late charge on past due balances of 1-1/2% per month or maximun rate allowed in customers state of residence.
* Whichever is less, and the reasonable cost of collection including attorney's fees.
* This order is subject to the acceptance of Delta Foremost Chemical Corp. Memphis, TN.
* Payment Terms - Net 30 Days / Credit Card at Time of Purchase

Credit Card Information.
Name on Credit Card		Credit Card User (Buyer)

Credit Card Type	Credit Card Number		Expiration Date	Verification Code

* Plus Applicable Freight & Sales Tax

Merchandise Total: 0