Tri-State Hose & Supply Co.
Pre-order Form - Print and Fax to 412-269-8977
| Customer: | ||
| Address (Shipping): | ||
| Phone: | Fax: | |
| Cell: | Email: | |
| Quantity: | Part #: | Description: |
| Required Deliver Date: | Freight Preference: | |
| Taxable or Tax Exempt (Certificate Required): | ||
| Method of Payment: (C.O.D.-Visa-MC-Amex): | ||
| Pertinent Info for Hose Assemblies (If Applicable): | ||
| Hose Size (ID): | ||
| Hose Length (overall Include End Fittings): | ||
| Hose Ends (male, female, straight, 90 etc.): | ||
| Pressures (Maximum Rated psi): | ||
| Temperature: | ||
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Application:
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