COUPON ORDER FORM

All pipe coupons come in 5” lengths
All pipe coupons have a 37 ½ deg. bevel on both ends
Bevels are machine cut ( not flame cut)
Material certifications will be sent upon request
Other sizes and materials will be quoted upon request

Pipe Size	Price Order	Quantity
2” Sch. 40	$6.00 each
2” Sch. 80	$9.00 each
2” Sch. 160	$12.00 each
6” Sch. 40	$18.00 each
6” Sch. 80	$23.00 each

COMPANY INFORMATION

*Company Name

*Company Phone

Street Address

City / State / Zip

*Person Placing Order

Purchase Order #

*Required information as we will contact you upon receipt of this order. We will require payment information and delivery date at that time. Please have this information available to our Accounts Payable Department.