Order Info

We have provided a simple order entry form from which you can order our products. We accept Visa and MasterCard as convenient forms of payment. If you prefer to use a company PO number, we have provided an option for that as well. International customers should Contact Us regarding acceptable forms of payment and conditions. Orders placed Saturday or Sunday will ship the following Monday.

Please review our Standard Terms & Conditions. Click to download and print a copy.
Standard Terms and Conditions Price List

Order Entry Form

Complete the information requested below.

Bill To:

Ship To: (if different than Bill To)

*Name:
Company:
*Address 1:
*Address 2:
*City:
*State/Province:
*Zip Code:
*Country:
*Daytime Phone:
Evening Phone:
*Email:

Name:
Company:
Address 1:
Address 2:
City:
State/Province:
Zip Code:
Country:
*Daytime Phone:

Please indicate the type of location:

Order Detail

Purchase Order No:

Date:

Silchem Quote No: *

Qty:    Price USD$*
Qty:    Price USD$*
Qty:    Price USD$*
Qty:    Price USD$*

* If you have not received a written Quote, See Price List for pricing.

Comments

Shipping Instructions

Package Service	Carrier Service	Shipping Payment Options
Next Business Morning	FedEx Air	Prepay & Add
Next Business Afternoon	FedEx Ground (standard)	Collect
Second Business Day	UPS Air	Shipper Acct No.
Third Business Day	UPS Ground	3rd Party Acct No.
Standard Available	US Postal Service	Allowed per Quotation
	Best Way

Payment Detail

Company Check (requires credit approval. Please fax bank and trade references)
*Card Number:---
*Expiration Date (mm/yy):
*Name on the Card:
*Card Verification Number (3 digit number found on the back of your card)

* Required information

Important Security Note: We have made every effort to ensure the security of the information you provide us. However, we understand that you may prefer to fax or call us with the above Payment Information. For your reference, our fax number is 901-328-1427 or call Customer Service at 760-798-4390.

Confirmation

Please indicate how you would like us to Confirm your order.

Email (requires entry in Bill To info) Fax (requires entry in Bill To info)
No Confirmation Required

Checkout

If you have completed entering your order, Checkout now.