PVC Industries, Inc.

/ Price Setup Request

CONFIDENTIAL

Set-up date: Terr: Present Supplier:

Customer name: How long in business:

Address: County:

City/State/Zip: Tax exempt # (Obtain

form)

Phone: Fax: Cell:

Contact: Position:

Delivery location:
Email address:
Acknowledgement: Fax ___ Email ___ Mail ___ Invoice: Fax ___ Email ___ Mail ___

Individual Corporation Partnership___ Principal name:

Home property: Own Rent ___ Social Security #:

Business property: Own Rent ___ Home Phone:

Prices:
Model % off list Options % off list

Trimlok Low-e

Trulok Argon

Grandlok Grids

Repl. Slider Obscure

Repl.Casement Foam Tape

Repl. Awning Sunclean

Hopper X jambs

By/Bow/Gdn Wasco

Primelok Locking Screen

Other _________
Balance preference: Block N Tackle Spiral Coil

Terms: Net 30: C.O.D.: Quotation: Reason: Credit limit:_____________

Use Credit Card on file:

Norman LaFleur.: Date: ____________________

Charles Long: Date: ____________________

Copy to office to expedite customer setup.