AXIS Inspection Group Ltd.

Revision #: 1
Revision Date: Nov 29, 2011
Issue Date: Apr 15, 2011
1239 Manahan Ave., Unit 204, Winnipeg, MB R3T 5S8
Phone: (204) 488-6790 Fax: (204) 415-5895
Website: www.axisinspection.com E-mail: info@axisinspection.com

Order From: Test Plate Assemblies

Company Name:

Billing Address: Shipping Address:

Street: Street:

City, Province: City, Province:

Postal Code: Postal Code:

Phone #: Contact:

Purchase Order #: Date of Order: Purchasing Rep:

Ship Via: Terms: RST Exemption # (MB only):

Quantity Item Description Plate Thickness Size of Gap Unit Price Total

811G Figure 8 Options 1 - Flat, Vertical, Overhead 3/8" 1/2" Gap

812G Figure 8 Option 2 - Horizontal 3/8" 5/16" Gap

911G Figure 9 Option 1 - All Positions 1/2" 5/8" Gap

Figure 8 SMAW & GMAW & FCAW/MCAW Figure 8 1-49 $12.00 each Subtotal

50+ $11.35 each GST 5%

Figure 9 - Alternately FCAW & MCAW Figure 9 1-49 $25.00 each RST 7% (MB)

50+ $23.50 each Shipping

Total

VISA or MASTERCARD #:

Expiry Date: Please Fax to: 204-415-5895

OR Email to:
Name on Card: Info@axisinspection.com

Authorized Signature:
Test assemblies will be shipped FOB
Optional: 1239 Manahan Ave., Unit B, Winnipeg,
MB. Please indicate Courier and
account number if you prefer to use
Courier Company preferred:
your own shipping company.
Alternatively, orders can be picked up
Courier Phone #: at our office.

Your Account #:
Submit by Email
Authorized Signature:

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