Ordering: Purchase Order Form

Please do not use this form if you are ordering for the first time.
Call 800.336.9828 to place your order.

Company Information

Bold fields are required.

(if known)

Product Information
Product Number Quantity Product Description
Shipping Information

Orders more than 12 cases will be shipped via truck. All other shipments will be via FedEx Ground unless otherwise indicated below:

Ship via Air ($38.00 CPI Hazmat Repacking Fee)
2nd Day
COD ($10.00 FedEx Fee)
Saturday Delivery (not available to all locations)

Special Instructions:

Truck Line: Only for shipments over 12 cases
Payment Information Purchase Order Number:

Payment Method:
Open Account
American Express

If paying by credit card, please complete the following:


Billing Address Same as Company Address

Chem-Pak, Inc.
Where Quality, Innovation, and Integrity Meet