Request for Quotation
(Please fill in the details and then click the "Submit RFQ" button)

Product Details
Line Item 1

Product Name - Grade - Part Number National Stock Number
Solicitation Number

Unit Type Units / Cyl. (SCF or Lbs.) Total Containers Total Units Part Number



Purity CGA Spec. Mil Spec.


Vendor Cylinder ----Gov't Cylinder --- If Gov't Owned, Pick-up Empties? --Yes --No
Gov't Owned Cylinders may require service (See Cylinder Service Price List) Check Services.

Hydrotest ----- Paint MIL 101B ----- New Valve
Approximate Quantity Requiring Service

Describe Application or Intended Use (Lab Instrument, Weapons, Air Cooler), this will help in evaluation of your request. Some Applications now require a greater purity than the MIL Assigned.

Bulk Requirements Data

# of Tanks --- Capacity of Each -- # Deliveries / Month (Est.)

Line Item 2

 

Product Name (Use Chemical or Tradename) National Stock Number Requisition Number

 

Unit Type Units / Cyl. (SCF or Lbs.) Total Containers Total Units Part Number



Purity CGA Spec. Mil Spec.


Vendor Cylinder ----Gov't Cylinder --- If Gov't Owned, Pick-up Empties? --Yes --No
Gov't Owned Cylinders may require service (See Cylinder Service Price List) Check Services.

Hydrotest ----- Paint MIL 101B ----- New Valve
Approximate Quantity Requiring Service

Describe Application or Intended Use (Lab Instrument, Weapons, Air Cooler), this will help in evaluation of your request. Some Applications now require a greater purity than the MIL Assigned.

Bulk Requirements Data

# of Tanks --- Capacity of Each -- # Deliveries / Month (Est.)

Contact Information

This data should reflect the Contracting Office Data. If this purchase is within the micro-purchase threshold and payable by IMPAC, then data applies to the purchaser / user.

Name Title

Company Symbol Building

City State/Province ZIP Code

Telephone - ---Fax - (In order to provide confidentiality, all responses are made by FAX.)

Email Address

Document Requirements

COA (Certificate of Analysis) (An extra cost, but very important for laboratories and critical calibration tests. Has complete breakdown of THC and other impurities.)

DCMC Inspection Required -------- At Destination ------- At Origin (Source)

MSDS w / shipment ( If shipping to a Hazmat Cell, we suggest an additional copy, otherwise you can print your own from this database.)

REFRIGERANTS - Copy of ARI 700 Report ( Evidence of chemical purity for reclaimed material, in accordance to the 40 Code of Federal Regulations, Part 82)

Payment Details

IMPAC CARD ------- EFT ------ Purchase Order (Invoice) ----- DD1155 (Fixed Price)

ATTENTION IMPAC CARD USERS: Do not supply your card number or data at this time or at any other time via Internet. Upon acceptance of our quote, we will request that your IMPAC Number be faxed to our office. Your card will not be debited until such time that the product is shipped. Upon shipping, we will FAX the Invoice and Bill of Lading.

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