TYPICAL CEMENT ORDER FORM EXAMPLE

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CUSTOMER NUMBER:       CUSTOMER ORDER NUMBER:

CUSTOMER NAME: ADDRESS:

DELIVERY DESTINATION:

CEMENT TYPE:
Type 1             Type 2             Type 1/2       Type 3
N Masonry       S Masonry       Fine Grind

For multiple order, use "Special Instructions" below.

QUANTITY: Pallets, or Bulk Tons, or Trucks.

REQUIRED: NOW!       DATE: TIME: A.M. P.M.

SUBMITTED BY: PHONE No:

SPECIAL or ADDITIONAL INSTRUCTIONS:

THIS ORDER IS SUBJECT TO ACCEPTANCE BY BEAUTIFYING CEMENTS INC AT ITS SALES OFFICE LOCATED IN CYBER SPACE.

      THANK YOU!

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