Name (of person filling out this form):

Customer:

If you are a new customer please supply your address

Street:

City: State: AL AK AS AZ AR CA CO CT DE DC FM FL GA GU HI ID IL IN IA KS KY LA ME MH MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND MP OH OK OR PW PA PR RI SC SD TN TX UT VT VI VA WA WV WI WY  ZIP:

Date Project is Needed

Item Description:

Typical Order Quantity:  Annual Volume:

If Specific Quantity Breaks are Needed, Please List:

Specifiy Units: MSI MIMP LBS MFT

Current Structure:

Quote Alternate Structure? Yes No

# of Colors:   Total:   Process:   Line:         

Surface or Reverse Print: Surface Reverse      Overlacquer? Yes No     Overall White? Yes No

% of Ink Coverage:     Sample(s) Provided:

Finished Slit Width:    Cutoff:

Roll Diameter (OD):    Core Size:

Gusset Info (location & width when spread open - if applicable):

Zipper? Yes No  Location & Style:

Material to be Supplied in Roll Stock or Pre-Formed Bags? Roll Stock Pre-Formed

Wind (Sealant in or out): In Out

Seal (Fin/Lap):

Special Packout Requirements (Poly Wrap Rolls, Cartons, etc.):

Other Helpful Information

Current Supplier:

Competition for this Pricing Opportunity:

Price Level Needed:

Customer's Machine:

Filled Package Weight:

Ship to Location:

Street:

City:   State: AL AK AS AZ AR CA CO CT DE DC FM FL GA GU HI ID IL IN IA KS KY LA ME MH MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND MP OH OK OR PW PA PR RI SC SD TN TX UT VT VI VA WA WV WI WY   ZIP:

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