HOUSTON, TEXAS | PHILADELPHIA, PENNSYLVANIA
1.800.923.9123 | 713.923.2222 | FAX 713.923.1111
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	PURCHASE ORDER NUMBER:
HAZMATPAC INC 5301 POLK STREET, BLDG 18 HOUSTON, TX 77023	BILL TO:
S/R: EXT:	CONTACT: EXT:
PHONE: 800-923-9123 or 713-923-2222 FAX: 713-923-1111	PHONE: FAX: CREDIT CARD NBR: E-MAIL:
PAYMENT TERMS: NET, 30 DAYS FREIGHT TERMS: F.O.B.ORIGIN Credit Card Number is Optional via World Wide Web	SHIP TO:
	CONTACT: EXT: PHONE:
	(For all FEDEX and RPS shipments)
FREIGHT COLLECT CARRIER ROUTING:	CARRIER A/C NBR:
(all UPS Shipments are freight collect)	CARRIER PHONE:
FREIGHT PREPAID & ADD TO INVOICE CARRIER#	DELIVERY HOURS

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CATALOG NBR	DESCRIPTION	QUANTITY	UNIT PRICE	EXTENDED COST
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DAMAGE WAIVER REQUIRED FOR GLASS SHIPMENTS VIA SPG			TOTAL:
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