COMPANY INFORMATION		Date:
Company Name:
Address:
City:	State:	Zip:
Contact Name:		E-Mail:
Phone:	Ext:	Fax:
WELDING INSTRUCTIONS/SKETCH (use separate sheet if necessary)
Steel Type:	Present Hardness:	Number of Pieces:
SHIPPING INSTRUCTIONS:
P.O. Number:
Call with estimated price and delivery:  { } Yes { } No