CHEMICAL ORDER FORM

You will receive confirmation of this order. Orders will be processed in the order they are received. Please allow 1 full business day for deliveries.

*COMPANY NAME             *REQUIRED

*DELIVERY LOCATION        FOR PICK UP

*CONTACT PHONE             *REQUIRED

*I NEED MY DELIVERY BY ASAP

SODIUM HYPOCHLORITE           QUANTITY 55 GALLON DRUM FILL UP MY CHLORINE CONTAINER SPECIFIED AMOUNT OTHER-SEE SPECIAL INSTRUCTIONS BELOW                    GALLONS 

CALCIUM HYPOCHLORITE         QUANTITY100lb TUBS

CHLORINE TABLETS 3"                 QUANTITY55lb  TUBS

MURATIC ACID                              QUANTITY15 GALL DRUM

SODIUM BICARBONATE              QUANTITY55lb BAG

STABILIZER                                    QUANTITY100lb TUBS

ALUMINUM SULFATE                   QUANTITY55 GALL DRUM (LIQUID)

                                                                                   50LB BAG

IF YOU DO NOT SEE YOUR CHOICE HERE PLEASE WRITE IT IN THE SPECIAL INSTRUCTIONS

PURCHASE ORDER NUMBER(If required)

SPECIAL INSTRUCTIONS:

   *REQUIRED FIELDS 

 IF YOU DO NOT RECEIVE A CONFIRMATION OF YOU ORDER YOUR ORDER HAS NOT BEEN PLACE PLEASE CONTACT US AT 1-512-846-2700.