CN-383-D HVI Color and Trash Calibration Standard Order Form

REPRODUCE LOCALLY

UNITED STATES DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE
COTTON AND TOBACCO PROGRAM
DATE:

ORDER #

DO NOT WRITE IN THIS SPACE
PAID BY CHECK NO.
AMOUNT

Standardization & Engineering Division
3275 Appling Rd.
Memphis, TN 38133
Telephone: (901) 384-3030
Fax: (901) 384-3032
E-mail: cotton.standards@ams.usda.gov

RECEIVED BY

DATE

HVI Color and Trash Calibration Standard Order Form
ITEM

U.S.

Calibration Color Tile Set - 5 Tiles

L1

(Check Colorimeter Type)

Incandescent

Xenon

Calibration Color Tile - Single Tile

L3

FOB Memphis

$XXX.XX

Surface Delivery

$XXX.XX

FOB Memphis

$XX.XX

Surface Delivery

$XX.XX

Color Check Box
(6 assorted cottons)

FOB Memphis

$XX.XX

Surface Delivery

$XX.XX

Universal HVI Cotton Color Standard
(12 assorted cottons)
Reassignment of Calibration Color Tile Set

FOB Memphis

$XX.XX

Surface Delivery

$XX.XX

FOB Memphis

$XX.XX

Surface Delivery

$XX.XX

FOB Memphis

$XX.XX

Surface Delivery

$XX.XX

(Check Tile and Colorimeter Type)
W
B
Y
G
C

L4
L5

EXPORT

L6

Xenon
Incandescent

(Check Colorimeter Type)

Incandescent
Trash Tile (1)

M1

Xenon

M2

FOB Memphis

$XXX.XX

Surface Delivery

$XXX.XX

M3

Single Cotton Image Under Glass
(Check One)

FOB Memphis

$XX.XX

Surface Delivery

$XX.XX

FOB Memphis

$XX.XX

Surface Delivery

$XX.XX

FOB Memphis

$XX.XX

Surface Delivery

$XX.XX

M4
M5

Request Quote for
Air Freight Pre-Paid

1

2

3

4

5

6

Leaf Guide Book (Check Type)
American Upland

American Pima

Tile Storage Box (Check Type)
Color Tile Box

Cotton Under Glass Box

$

Request Quote for
Air Freight Pre-Paid
Request Quote for
Air Freight Pre-Paid
Request Quote for
Air Freight Pre-Paid
Request Quote for
Air Freight Pre-Paid
Request Quote for
Air Freight Pre-Paid

(Check Lighting Type)

Incandescent
Xenon
Cotton Images Under Glass
(6 Trash Levels)

DOLLAR
AMOUNT

QUANTITY

Request Quote for
Air Freight Pre-Paid
Request Quote for
Air Freight Pre-Paid
Request Quote for
Air Freight Pre-Paid
Request Quote for
Air Freight Pre-Paid

Totals

$

PAYMENT MUST BE SUBMITTED WITH ORDER. WE DO NOT ACCEPT LETTERS OF CREDIT.
CHECK MUST BE DRAWN ON A U.S. BANK PAYABLE TO : USDA, AMS, COTTON AND TOBACCO PROGRAM.
CHECK
VISA
MC
ACCT. NO.
EXPIRES
SIGNATURE
PRICES: Price of standards includes packaging, handling and delivery where stated. Fumigation (if needed) is a minimum of $XX.XX per order.
Phytosanitary Certificate (if needed) is $XX.XX.

SHIP TO (print or type)
CONTACT NAME

COMPANY NAME

STREET ADDRESS (necessary)

POSTAL BOX

STATE, COUNTRY, AND ZIP CODE

E-MAIL ADDRESS

PHONE

CITY
FAX

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of
information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0581-0008. The time required to
complete this information collection is estimated to average 4 minutes per response, including the time for reviewing instructions, searching existing data
sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.
In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and
employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, religion,
sex, gender identity (including gender expression), sexual orientation, disability, age, marital status, family/parental status, income derived from a public
assistance program, political beliefs, or reprisal or retaliation for prior civil rights activity, in any program or activity conducted or funded by USDA (not all bases
apply to all programs). Remedies and complaint filing deadlines vary by program or incident.
Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large print, audiotape, American Sign
Language, etc.) should contact the responsible Agency or USDA’s TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA through the Federal
Relay Service at (800) 877-8339. Additionally, program information may be made available in languages other than English.
To file a program discrimination complaint, complete the USDA Program Discrimination Complaint Form, AD-3027, found online at
http://www.ascr.usda.gov/complaint_filing_cust.html and at any USDA office or write a letter addressed to USDA and provide in the letter all of the information
requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by: 1) mail: U.S.
Department of Agriculture Office of the Assistant Secretary for Civil Rights 1400 Independence Avenue, SW Washington, D.C. 20250-9410; 2) fax: (202) 6907442; or 3) email: program.intake@usda.gov.
USDA is an equal opportunity provider, employer, and lender.

CN-383-D (12-06)