| Make check payable to: |
To order please print this form
and mail or Fax W/ payment. |
Date:________________ |
D & D Chemical, Inc.
P.O. Box 157
Grifton, NC 28530
1(252)523-8255 |
Fax: 1-252-523-8255 |
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| Mail to: |
Ship to: |
Phone: |
| _____________________ |
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____________________ |
| _____________________ |
_____________________ |
Email: |
| _____________________ |
_____________________ |
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| _____________________ |
_____________________ |
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| ( )UPS
( ) US Postal Service |
Credit Card number:
______________________________ Exp:____________ Name on
Card: __________________________________
( )Visa ( )Mastercard |
Products will be shipped when out of state check
have cleared our bank.
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