Niagara Caps & Plugs

Standard Package

The following form may be used to order Standard Package quantities. Your order will be sent electronically and a customer service representative will get back to you with a confirmation. If you are an existing Niagara customer and know your customer number, including it will expedite your order.

Fields with * must be completed

Billing Information

Customer Number		PO Number
* First Name:		* Last Name:
* Company Name
* Address
Address
* City, State, Postal Code
PA Residents ONLY- Tax Exemption Number
Country Code
* Telephone
Fax
* E-Mail Address

Company Profile

Industry (or SIC Code)
Intended Application (e.g., product protection, finishing, masking, packaging, etc.)
Estimated Annual Usage
Anticipated Order (e.g. 1 month, 2 month, etc.)

Shipping Information

* Is the shipping address the same as the billing address?	Yes ( Please check box if the same)
Attention Of
Address
Address
City, State, Postal Code
Country Code

Customer Part Number	Niagara Part Number	Color and Material	Quantity (# of Packages)	Date Needed

Questions / Comments

Literature Request Also, please send me the following literature:
Master Catalog Includes product descriptions, application photos, dimensions and material/color specifications.		Custom Products Describes step-by-step the custom process from design to shipping.		Pipe and Flange Specific to pipe and flange protection. Includes photos, dimensions and specifications.


	Master Catalog		Custom Products Brochure		Pipe and Flange Brochure

I have read and accept the terms and conditions regarding the purchase of products from the Niagara Caps & Plugs Co. I realize that there will be a restocking fee involved with any return of purchased items and as such it is my responsibility to take advantage of Niagara's offer of free samples to verify a product before purchasing it.

QS 9000 - ISO 9001 Certified, Copyright 2004 Niagara Caps & Plugs

Niagara Caps & Plugs • 7090 Edinboro Road • Erie, PA, USA 16509-4497
Phone: 1-800-458-0465 or 1-814-868-3671 • Fax: 1-800-358-4391 or 1-814-864-2423 • e-mail: info@NiagaraCapsandPlugs.com

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