Central Industrial Supply, Inc. | Request for Prices

Order Form

Note: If you would like a price request, please e-mail or call one of our sales staff.

In order to place an order using this form, you must have an established account and be a recognized customer of CIS. For information on establishing an account, please contact Betsy McLaren at 318-628-2776.

Date
Purchase Order Number
Name
E-mail address
Company
Address
Phone Number
Fax Number

Order

	Item Number	Quantity	Item Description
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Please state any special instructions, comments in the box below.

You may also e-mail your order, with all of the above information to: orders@ci-supply.com