DOW CORNING 200 FLUID ORDER FORM

DOW CORNING®
200 FLUID®
ORDER FORM

Please fill out the information below. We will first need your Purchase order Number. Then the information nessesarry to bill and ship the Damper Fluid.

You will recieve an acknowledgement from a real person usually within one business day. Most Custom Viscosities are shipped within one business week.

The price at the bottom will be a subtotal for your order... shipping and handling are added to the subtotal. Shipping charges are for domestic orders only, any others will be quoted individually.

Remember: use the TAB key to move from one field to the next, the Shift+TAB key to move back to a previous field, OR place the cursor with your mouse.


PLEASE FILL IN ALL REQUIRED FIELDS
*DENOTES FIELDS THAT ARE REQUIRED

Purchase Order No.:
*Your Name:	*
Your Position:
*Company:	*
MAIN COMPANY ADDRESS		SHIP TO ADDRESS IF DIFFERENT
*Address1:	*	Address1:
Address2:		Address2:
*City:	*
*State/Province:	*
*ZIP/Postal Code:	*	*Country:	*
*Phone Number:	*	FAX Number:
*e-mail address:	*


Please be sure to fill in all the necessary fields. If Custom, then the Viscosity Quantity (number of bottles) Size container Then press the "SUBMIT" button. Thank you.
PRICES ARE IN US CURRENCY
Minumum order is $50.00

Viscosity:		Quantity:	Size:
200 cs fluid:
1000 cs fluid:
60,000 cs fluid:
Custom Viscosity #1:	c.s.
Custom Viscosity #2:	c.s.
Custom Viscosity #3:	c.s.

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DOW CORNING®200 FLUID®ORDER FORM

DOW CORNING®
200 FLUID®
ORDER FORM