Alken-Murray Corporation header on order form

Order Form
  • Please complete this form by TYPING from your computer, Then PRINT the form (using your computer printer), then SIGN below credit card details

FAX completed form to:

1+ (540) 636-1770



Master Card and Visa Charge cards, certified checks, money orders and advance bank-to-bank wire transfers.

Date: Purchase Order No.

Company name:

Billing/Mailing Address (should match credit card billing address):

City State

Country Zip Code

E-mail address

Telephone No.

Fax No.

Contact name:

Your Distributor Contact (if you are an AM authorized distributor, list your company here)

If you live in Virginia, Are you taxable? Yes No

(If you live in Virginia and are not taxable, attach tax exemption certificate copy.)

Shipping Address: (fill in even if it matches billing address - to confirm)

City State

Country Zip Code

Telephone No. Fax No.

Contact name:


Fax No.





(if known)





































Master Card or VISA Number Alken-Murray accepts ONLY Master Card or VISA charge cards

Expiration date of credit card:

3 digit security code on back of card

Zip Code for credit card statement mailing


Please DO NOT send charge card number in an e-mail. FAX only.

Signature of credit card holder below is required for us to accept credit card orders. Thank you.

Company Identification Number Required For Customs in Your Country (if any):


Special billing instructions:


Special labeling, packaging instructions & IHT* selection (foreign):

*International Harmonized Tariff Code (IHT)

Does Your Country Ban Soft-Wood Pallets? Yes No

Does Your Country Require a Certificate of Origin for AM products, authenticated by a US Chamber of Commerce? Yes No

Does Your Country Require a valid IMPORT LICENSE for the products you are ordering? Yes No

If yes, provide license number here and fax copy of license with this order. Thank you.

If product is detained in customs because you lack a required import license,after declaring above that none is required, you hereby agree to pay charges of altering the addressee to someone with the required license, and any storage fees accumulated while waiting for authorization to make this change. If such change is not completed within 30 days after product arrives in your country, you agree to pay shipping charges both directions (to you and return to us) along with storage in customs pending your decision to allow return to us. If product is returned to us, we will refund product cost minus a 15% restocking charge for products other than nitrifiers (CF 1100-50x, 1400-50x or 7110-50x), which have a 75% restocking charge), credited against return freight and storage fees accumulated prior to return to us.

Shipping preferences:

Nitrifiers ship by Federal Express Next Day or International Priority ONLY

Federal Express SONIC (fastest possible, potentially same-day, VERY EXPENSIVE - USA only)

Federal Express Next Day Morning (USA and Canada ONLY)

Federal Express International Priority (Export ONLY)

Federal Express Next Day Afternoon (USA and Canada ONLY)

Federal Express 2nd Day (USA and Canada ONLY)

Federal Express 3rd Day Select (USA and Canada ONLY)

Federal Express Ground (mainland 48 states USA, Canada and Mexico)

Federal Express International Economy (Export)

R & L Freight (ground, most of the USA)

Pitt-Ohio (ground, certain parts of the USA)

Yellow Freight Ground (in lower 48 states of USA and Canada)

DHL-Global Forwarding (better rates for pallets of product by air or ocean, internationally)

Other freight carrier:or forwarder, please specify name and USA contact information.

If shipment is to be collect on your account, then please list your account number with the carrier of your choice, or other codes necessary for them to know that you have authorized this shipment. UPS does not accept collect shipments unless the shipper ALSO has a UPSaccount and Alken-Murray does not, but most freight carriers do not have this requirement


Your account number with carrier selected above


Do you need a freight quote before we process your order? Yes No

Do you need a pro-forma invoice before we process your order? Yes No 

If you need a blanket sales tax exemption certificate, click HERE, fill in on-line and FAX with order.

Do you require notification of shipment tracking number after order is shipped? Yes No

If you want tracking information, how do you want it sent to you?

If by e-mail, give e-mail address

If by telephone, give telephone number

If by fax, give fax number

How were you referred to Alken-Murray products?

  • Another Satisfied Alken-Murray Client
Name of Referring Client
  • Local Alken-Murray Distributor Name
  • Former Alken-Murray client , without current database profile
Name of Referring Client
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