CN-383-A HVI Calibration Cotton Standard Order Form

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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 Calibration Cotton Standard Order Form
Universal HVI Calibration Cotton Standards
ITEM

I1
I2

Universal
Short-Weak
Universal
Long-Strong

HVI UHM
LENGTH
(inches)

HVI
UNIFORMITY
INDEX (%)

HVI 1/8"
STRENGTH
(g/tex)

MICRONAIRE

Below X.XX

XX - XX

XX - XX

X.X - X.X

X.XX - X.XX

XX - XX

XX - XX

X.X - X.X

DOLLAR
AMOUNT

QUANTITY
$

ELS (Extra-Long Staple) HVI Calibration Cotton Standards

H1
H2

ELS
Short-Weak

X.XX - X.XX

XX - XX

XX - XX

X.X - X.X

X.XX+

XX - XX

XX+

X.X - X.X

ELS
Long-Strong

Totals

$

Exact test values for each calibration cotton are shown on the label of each sample. These values are established by designated laboratories.
The samples are raw cotton.
PRICES: The price of each 5 pound sample 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.

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
EXPORT

UNITED STATES
FOB Memphis...
Surface Delivered...

$XX.XX

Request Quote for Air Freight Pre-Paid

$XXX.XX

SHIP TO (print or type)
COMPANY NAME

CONTACT NAME
STREET ADDRESS (necessary)
POSTAL BOX

CITY

PHONE

STATE, COUNTRY, AND ZIP CODE

E-MAIL ADDRESS

FAX

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

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
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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,
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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) 690-7442; or (3) email: program.intake@usda.gov. USDA is an equal opportunity provider, employer, and lender.

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