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

REPRODUCE LOCALLY

FORM APPROVED – OMB NO. 0581-0008

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

ORDER #
DO NOT WRITE IN THIS SPACE

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

PAID BY CHECK NO.

AMOUNT

RECEIVED BY

DATE

HVI Color and Trash Calibration Standard Order Form
ITEM

U.S.

Calibration Color Tile Set - 5 Tiles

L1

(Xenon)
Calibration Color Tile Set - Single Tile

L3

W

B

Y

G

C

EXPORT

FOB Memphis

$XXX.XX

Surface Delivery

$XXX.XX

FOB Memphis

$XX.XX

Surface Delivery

$XX.XX

L4

Color Check Box
(6 assorted cottons)

FOB Memphis

$XX.XX

Surface Delivery

$XX.XX

L5

Universal HVI Cotton Color Standard
(12 assorted cottons)

FOB Memphis

$XX.XX

Surface Delivery

$XX.XX

L6

Reassignment of Calibration Color Tile Set

FOB Memphis

$XX.XX

Surface Delivery

$XX.XX

M1

Trash Tile (1)
(Xenon)

FOB Memphis

$XX.XX

Surface Delivery

$XX.XX

M2

Cotton Images Under Glass
(6 Trash Levels)

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

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 .

QUANTITY

Request Quote for
Air Freight Pre-Paid

DOLLAR
AMOUNT
$

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

ACCT. NO.
EXPIRES
SIGNATURE
CHECK
VISA
MC
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

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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.
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CN-383D (Exp. X/XXXX) Destroy previous editions.