Company Name

   Contact Name
                 Phone
                     Fax
                  Email

Quantity:
        Release Quantity
        Expected Future Annual Quantity

       Date Needed:

Pipe Type:

Diameter:

Length:
       Inches
       Eights

Special End Characteristics:
               End 1                                        End 2
                  Threaded                            Threaded
                  Ream & Chamfer              Ream & Chamfer
                  Square Cut                         Square Cut
                  RollerCut                           RollerCut

Other Special Characteristics:
                  Vict Groove
                  Reducing
                  Butt
                  ERW

Intended Use and Comments: