DUKE SALT & BAGGED ICE MELTS: QUOTE & ORDER FORM Which Duke Store Should the Quote / Order Be Forwarded to?Store Name* Rochester Ithaca Dansville Auburn Select* Quote Form Order Form Taken By:* First Last Date* MM slash DD slash YYYY Time* : Hours Minutes AM PM AM/PM Delivery InformationDelivery Date* MM slash DD slash YYYY Delivery Time* : Hours Minutes AM PM AM/PM Delivery Hours: Customer InformationExisting or New Customer?* Existing Customer New Customer Customer NumberAccount with Duke: Yes / No?* Yes No Customer Name* Contact (Person Placing Order)* First Last Customer Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Customer PhoneCustomer Mobile*Ship To:Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Ship to Contact:* First Last Cell:*Ship to Email:* Purchase Order # Sales Rep: Source: Trucking Company: Truck Type Which Customer Should the Quote / Order Be Emailed to?Customer Email Address Rental / Sale Item(s)Item 1Bulk Rock Salt and Bagged Ice Melts*Bulk Rock SaltAmerican Rock Salt (Bagged)Environment (Bagged)Ice Beater Treated Ice Melter (Bagged)Ice Cutter Ice Melter (Bagged)Mr. Magic (Bagged)Polar Ice Melt Flake (Bagged)Pro Grade Commercial Strength (Bagged)Pro Grade Fire Crystal (Bagged)Pro Grade Polar Vortex (Bagged)Stealth Blue (Bagged)Vaporizer Calcium Chloride (Bagged)Vaporizer Calcium Flake (Bagged)Quantity Quantity Type Ton(s) Pallet(s) Bag(s) Description Sales $*Additional Item to Add? (1)* Yes No Item 2Quantity Model # Unit # Description* Sales $*Day $*Week $*Month $*Length of Rental Day Week Month Days1 Day2 Days3 Days4 Days5 Days6 Days7 Days8 Days9 Days10 DaysWeeks1 Week2 Weeks3 Weeks4 Weeks5 Weeks6 Weeks7 Weeks8 Weeks9 Weeks10 WeeksMonth(s)1 Month2 Months3 Months4 Months5 Months6 Months7 Months8 Months9 Months10 Months11 Months12 MonthsAdditional Item to Add? (2) Yes No Item 3Quantity Model # Unit # Description* Sales $*Day $*Week $*Month $*Length of Rental Day Week Month Days1 Day2 Days3 Days4 Days5 Days6 Days7 Days8 Days9 Days10 DaysWeeks1 Week2 Weeks3 Weeks4 Weeks5 Weeks6 Weeks7 Weeks8 Weeks9 Weeks10 WeeksMonth(s)1 Month2 Months3 Months4 Months5 Months6 Months7 Months8 Months9 Months10 Months11 Months12 MonthsAdditional Item to Add? (3) Yes No Item 4Quantity Model # Unit # Description* Sales $*Day $*Week $*Month $*Length of Rental Day Week Month Days1 Day2 Days3 Days4 Days5 Days6 Days7 Days8 Days9 Days10 DaysWeeks1 Week2 Weeks3 Weeks4 Weeks5 Weeks6 Weeks7 Weeks8 Weeks9 Weeks10 WeeksMonth(s)1 Month2 Months3 Months4 Months5 Months6 Months7 Months8 Months9 Months10 Months11 Months12 MonthsAdditional Item to Add? (4) Yes No Item 5Quantity Model # Unit # Description* Sales $*Day $*Week $*Month $*Length of Rental Day Week Month Days1 Day2 Days3 Days4 Days5 Days6 Days7 Days8 Days9 Days10 DaysWeeks1 Week2 Weeks3 Weeks4 Weeks5 Weeks6 Weeks7 Weeks8 Weeks9 Weeks10 WeeksMonth(s)1 Month2 Months3 Months4 Months5 Months6 Months7 Months8 Months9 Months10 Months11 Months12 MonthsAdditional Item to Add? (5) Yes No Item 6Quantity Model # Unit # Description* Sales $*Day $*Week $*Month $*Length of Rental Day Week Month Days1 Day2 Days3 Days4 Days5 Days6 Days7 Days8 Days9 Days10 DaysWeeks1 Week2 Weeks3 Weeks4 Weeks5 Weeks6 Weeks7 Weeks8 Weeks9 Weeks10 WeeksMonth(s)1 Month2 Months3 Months4 Months5 Months6 Months7 Months8 Months9 Months10 Months11 Months12 MonthsAdditional Item to Add? (6) Yes No Item 7Quantity Model # Unit # Description* Sales $*Day $*Week $*Month $*Length of Rental Day Week Month Days1 Day2 Days3 Days4 Days5 Days6 Days7 Days8 Days9 Days10 DaysWeeks1 Week2 Weeks3 Weeks4 Weeks5 Weeks6 Weeks7 Weeks8 Weeks9 Weeks10 WeeksMonth(s)1 Month2 Months3 Months4 Months5 Months6 Months7 Months8 Months9 Months10 Months11 Months12 MonthsAdditional Item to Add? (7) Yes No Item 8Quantity Model # Unit # Description* Sales $*Day $*Week $*Month $*Length of Rental Day Week Month Days1 Day2 Days3 Days4 Days5 Days6 Days7 Days8 Days9 Days10 DaysWeeks1 Week2 Weeks3 Weeks4 Weeks5 Weeks6 Weeks7 Weeks8 Weeks9 Weeks10 WeeksMonth(s)1 Month2 Months3 Months4 Months5 Months6 Months7 Months8 Months9 Months10 Months11 Months12 MonthsAdditional Item to Add? (8) Yes No Item 9Quantity Model # Unit # Description* Sales $*Day $*Week $*Month $*Length of Rental Day Week Month Days1 Day2 Days3 Days4 Days5 Days6 Days7 Days8 Days9 Days10 DaysWeeks1 Week2 Weeks3 Weeks4 Weeks5 Weeks6 Weeks7 Weeks8 Weeks9 Weeks10 WeeksMonth(s)1 Month2 Months3 Months4 Months5 Months6 Months7 Months8 Months9 Months10 Months11 Months12 MonthsAdditional Item to Add? (9) Yes No Item 10Quantity Model # Unit # Description* Sales $*Day $*Week $*Month $*Length of Rental Day Week Month Days1 Day2 Days3 Days4 Days5 Days6 Days7 Days8 Days9 Days10 DaysWeeks1 Week2 Weeks3 Weeks4 Weeks5 Weeks6 Weeks7 Weeks8 Weeks9 Weeks10 WeeksMonth(s)1 Month2 Months3 Months4 Months5 Months6 Months7 Months8 Months9 Months10 Months11 Months12 MonthsCartage FeesDelivery Charge ($):*Special Delivery Instructions Δ