1011 Greenfield | P.O. Box 106 | Tifton, Ga 31793 
229-382-2000 or 800-338-7881 
Fax: 229-386-5035

  
Customer Re-Order Form

 
  
Name: *
Company Name:*
E-mail Address:*
Daytime Phone:*
City
State
 

  
Re-Order Info

  
Item Reorder Number
Item Description/Name
Quantity
Starting # (If applicable)
Last invoice date
Purchase Orders # (if applicable)
Exact Repeat:

Yes  or No *

 

Item 2 Reorder Number
Item 2 Description/Name
Quantity
Starting # (If applicable)
Last invoice date
Purchase Orders # (if applicable)
Exact Repeat:

Yes  or No*

 

 

 

 

 

 

 

Item 3 Reorder Number
Item 3 Description/Name
Quantity
Starting # (If applicable)
Last invoice date
Purchase Orders # (if applicable)
Exact Repeat:

Yes  or No*

 

 

 

 

 

 

 

Item 4 Reorder Number
Item 4 Description/Name
Quantity
Starting # (If applicable)
Last invoice date
Purchase Orders # (if applicable)
Exact Repeat:

Yes  or No*

 

 

 

 

 

 

 

* If no, describe changes below in Comments/Description section

 

 

Comments / Description