Nutrin Nutritional Ingredients

Nutrin
Distribution
Company

Purchase Order:

FAX (815) 550 6246

ATT: Order Dept

MAIL:

Nutrin Distributions Co. / Order Dept
P.O. Box 65048,
Washington, DC 20035

TODAY'S DATE:____________________

(For ease of use and to insure promptness this form can be printed, completed and then faxed or mailed to Nutrin. You will receive a confirmation when we receive your order.)

Name of Organization___________________________________

Name of Purchasing Agent: __________________________________

Do you wish to ship to your standard shipping point?

Yes / No

If "No", please enter shipping address below.

Shipping Address (Street 1)___________________________________

Shipping Address (Street 2)___________________________________

Shipping Address (City)___________________________________

Shipping Address (State of Province)____________________________

Shipping Address (ZIP or Postal Code)_________________________________

Shipping Address (Country)____________________________

Date you require product to arrive at your location by ______________

Date you wish product to ship from our warehouse: ____________

Purchase Order # _____________

How do you wish to ship the product?

You will pick up (Please make pick-up appointment 24 hrs prior)

Nutrins freight broker (freight collect)

Your Preferred Carrier

If Your Preferred Carrier is selected, please specify name of carrier and

telephone number.

Name_________________________- Telephone Number _____________________

Products:

PARTIALLY DEFATTED PEANUT FLOUR

Bland: ____ 25 Kg cases x $ __________ per case = $__________

Medium: ____ 25 Kg cases x $ __________ per case = $__________

Strong: ____ 25 Kg cases x $ __________ per case = $__________

X-Strong: ____ 25 Kg cases x $ __________ per case = $__________

TOTALLY DEFATTED PEANUT FLOUR

Bland: ____ 25 Kg cases x $ __________ per case = $__________

Medium: ____ 25 Kg cases x $ __________ per case = $__________

Strong: ____ 25 Kg cases x $ __________ per case = $__________

PEANUT EXTRACT:

Roasted ____ 55 gl drums x $ __________ per drum = $__________

PEANUT PASTE / BUTTER:

Code_______ ____ 25 Kg cases x $ __________ per case = $__________

Code_______ ____ 55 gl drums x $ __________ per drum = $__________

PARTIALLY DEFATTED PEANUTS:

Code_______ ____ 30 Kg cases x $ __________ per case = $__________

PEANUT OIL:

AROMATIC ____ 55 gl drums x $ __________ per drum = $__________

ROASTED ____ 55 gl drums x $ __________ per drum = $__________

TOTAL ORDER: $_____________

Someone from Nutrin will contact you with confirmation within the next 24 Hours.

Thank you for your order.