Dixie Rubber & Plastics

To place an order online. complete this form. You must have an established account with Dixie Rubber or provide complete credit card information with your order.

You may also place orders by telephone at (864) 233-7433 or by fax at (864) 271-7721.

Please do not use this form for anything other than placing orders.

If you have general comments or questions not directly related to a purchase, please use our contact form to submit your inquiry.

Online Order Progress: Contact Order Items Shipping & Payment

Contact Information

Contact Name :
Email Address:

Job Title/Department:
Phone Number (with area code):
Fax Number (with area code):

Company Name:

Ship-to Name:
Shipping Address:
Shipping Address 2
City State Zip

Bill Attention To:
Company Name:
Billing Address:
Billing Address 2
City State Zip

Order Items & Details

Item	Qty	Units	Description (materials, grade. color, etc)	Dimensions-inches	price/ unit
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IMPORTANT NOTICE: Applicable taxes and shipping
costs will be added to your order before billing

Pricing Information

To expedite your order, please provide the following information regarding your pricing information.

The source of the pricing entered above is:
The approximate timeframe of this pricing is:
Dixie Rubber & Plastics Sales person:
Comments or additional information regarding this pricing:

Shipping & Payment Information

Shipping Method
Preferred Carrier:
Other Carrier:
Select Service Level:

Payment Method - Any Customer
Credit Card Type:
Credit Card Number: Card Security Code:
Expiration Date:

Existing Dixie Rubber Customers
Your Customer Number:
Your Purchase Order Number:
Requested Payment Terms:

ORDER CONFIRMATION
How would you like for us to confirm your order:

Other comments or requests:

Please check your order CAREFULLY. In-stock items will ship quickly. Once you hav verified your order information, please confirm the order by checking the box below:

ORDER CONFIRMED.