LUFKIN

MIDDLE EAST Request Date:

Buyer: Ghada El-Sherif

SUPPLIER REQUEST FORM

X New Change

Company Name:

Remit to Address:

Terms of Payment: IMM (Explain if other than Net 30 Days)

EGP Currency – Via: CHK Monthly Payroll
Contact Name:

Contact Phone: Contact Fax:

Contact e-mail Address:

Requestor’s Signature: Ghada El-Sherif

………………………………………………………………………………………………………

ASSIGNED SUPPLIER NUMBER:

(If Change, please put Supplier number to be changed.)

Add/Change Made By: Date Made:

PLEASE TYPE OR PRINT LEGIBLY. ALL REQUESTED INFORMATION MUST BE PROVIDED.

(If the supplier does not have an email address, insert “None”)