TEXAS BARREL SUPPLY PURCHASE INQUIRY FORM

Please complete all information below then submit this form.

IMPORTANT:  Shipping is NOT included in cost of barrels & parts.
Contact us for shipping quote BEFORE ordering barrels.

Name:

Address:

City:

State:       Zip:

Phone:           Cell Phone:

Best Time To Call:    A.M.    P.M.

Email:

If you are picking up barrels, please specify the date and time you want to pick them up.
Date: Time:    A.M.    P.M.

If you want the barrels shipped, indicate where to ship them if other than the above address.
Ship to:
This is a business residence .

Again, please contact us about shipping.

BARREL & BARREL COMPONENT PURCHASE

Type of Barrels: Steel      Poly     Number of Barrels Needed:

Barrel Fittings & Componants: Liner:      Lever Lock Rings:      Bolt Lock Rings:

Valve Assembly Kit :      Bolt Lock Rings:      Bung Closures:

Method of Payment: Wire Funds       Credit Card via Paypal

Please provide additonal information that will help us supply you with the type of barrel you are looking for (i.e. do you need open top, closed top, trash barrel, deer feeder barrel, barrel suitable for liquids, storage barrel, etc?)

COMPLETE THIS PORTION FORBARREL RENTAL   - Complete portion, below, for barrel rental only

Type of Barrels: Steel      Poly   Number of Barrels Needed:

How many days? :

Method of Payment: Wire Funds       Credit Card via Paypal

Please provide additonal information that will help us supply you with the type of barrel you are looking for (i.e. do you need open top, closed top, trash barrel, deer feeder barrel, barrel suitable for liquids, storage barrel, etc?)

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Thank you.  We will contact you shortly.

Texas Barrel Supply