Quote Request Form

Customer Name (Name and City / State) or Customer ID *

One Time / Ongoing *

Timing (When Inventory is Needed)

Deadline for Quote

Items to Quote *

Please provide the Item Number / Volume / Unit of Measure / Time Frame of Usage / Target Price of Discount. All information needs to be complete, with one item per line Example: ALXP-1826 / 10,000 / Each / Annual Volume / Inventory Taken Every Month / Target 2% Discount

Submitted by Name

Submitted by Email Address *