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116 Sunset Inn Road, P.O. Box 300, Lafayette NJ 07848 Phone (973) 579-3448 E-mail petrolube@nac.net Fax (973) 579-9447 |
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This form MUST accompany all samples. In order to avoid delays, please complete ALL sections of this form. |
| Date:
Contact Name:
Phone #: Fax #: email: |
Company Name:
Address:
|
Testing Required: Please
list: Test Method, Time/Temperature, Material Specification, etc.
___________________________________________________________________________
[ ] RUSH
TESTING – ALL RUSH TESTING MUST BE PRE-APPROVED and will incur at least
a 50% surcharge.
CALL 973-579-3448 FOR PRE-APPROVAL
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Contact Person @ Petro-Lube:_____________________________________ Scheduling of Rush testing will be delayed or may not be available in absence of pre-approval. |
Note: We do our utmost to meet rush requests but owing to unforeseen circumstances we do not guarantee results by a particular date in every instance. |
| [ ] Purchase Order No.
#_____________ Net 30 days |
[ ] Visa, MasterCard, American
Express
Card Number: Expiration Date: |
[ ] Pre-Payment
Check #: Amount $ |