On-Line Order Form

To place your order with us on-line, please complete the form below.
You must have an established account with us or provide the credit card account
information requested in all fields for us to complete your order. Your order will
be confirmed by the method you select at the bottom of the order form below.

IF YOU DON'T WISH TO PLACE AN ORDER,
PLEASE DON'T USE THIS FORM.

Instead, use our Contact Form to check pricing or stock availability,
request literature, or ask for technical assistance with plastic materials.

If you're concerned about providing confidential information to us, you can
review our Information Privacy Policy Statement before you complete the form.

If your browser or computer system doesn't support the Forms or Tables used below,
just give us a call at 1-800-444-3485, FAX your order to 1-361-594-2349, or contact us by e-mail.

BPI Home Page | Applications Guide | Materials Guide | Contact Us

Please Complete the Order Form Below and Send It

RELOAD MY LAST SUBMITTED ORDER FORM
be sure to check entire form carefully if you use this reload feature!

N O T E : A L L F I E L D S A R E R E Q U I R E D
C O N T A C T I N F O R M A T I O N
	Mr. Mrs. Ms.
Your Name:	*
Job Title / Dept:
Your Company:	*
E-Mail Address:	*
Phone Number:	*
FAX Number:
S H I P P I N G A D D R E S S
SHIP Attention to:
Company Name:
SHIPPING Address 1:
Address 2:
City:
State/Province:
Zip/Postal Code:
Country:
B I L L I N G A D D R E S S
BILL Attention to:
Company Name:
BILLING Address 1:
Address 2:
City:
State/Province:
Zip/Postal Code:
Country:

O R D E R I T E M S A N D D E T A I L S
Item	Qty	Units	Description material,grade,color,etc.	Dimensions (inches) thickness,diameter,length,width	price per unit	extended price
01					$	$
02					$	$
03					$	$
04					$	$
05					$	$
06					$	$
07					$	$
08					$	$
09					$	$
10					$	$

M A T E R I A L S U B - T O T A L					$
* * * IMPORTANT NOTE: Applicable Taxes and Shipping Costs will be added to your order before billing * * *

P R I C I N G I N F O R M A T I O N
To expedite your order, please indicate your source for pricing entered above:
The source of the pricing you entered was:
The approximate time frame of pricing was:
Boedeker Plastics salesperson's name:
Any further explanation:
S H I P P I N G M E T H O D
Choose Carrier: Other Carrier:		Choose Delivery: Other Time: (choice subject to availability in your area)
P A Y M E N T M E T H O D
Any Customer (new or existing): Choose Credit Card Type: Card Number: Expiration Date: Card ID Number: * How to find your CID#		Existing BPI Customers ONLY: Your Customer Number: Your Purchase Order#: Requested Payment Terms:
We accept the following charge cards:
O R D E R C O N F I R M A T I O N
How would you like us to confirm your order? :
Any Other Comments about Your Order?
Please check your order CAREFULLY as we ship items in stock very quickly! Once you have checked your order, please confirm by checking the box below: Yes, process my order NOW. *
- or -

Information Privacy Policy Statement
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http://www.boedeker.com/order.htm

Boedeker Plastics, Inc.
904 West 6th Street, Shiner, Texas 77984 USA
USA TOLLFREE : 1-800-444-3485
Phone: 1-361-594-2941 Fax: 1-361-594-2349 E-Mail: bpi@boedeker.com