Contact Name:

Company Name:

Phone: Fax:

E-mail Address:

Mailing Address:

Shipping Address:

Quantity:

Type of Material :

Give a detailed description of the material to be ground below. Include information about paper labels, metal, screws, or any other contaminant that will need to be removed.

Approximate date needed:

Will we handle freight or will you deliver?

Additional information:

If you prefer, you can print and fax this form to Ed Barker at 812-897-0123.