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Form 47-268 STANDARD QUOTATION & SPECIFICATION FORM VENDOR OF RECORD: 1. STATE: 3. BRAND NAME: 5. STATE STOCK: 8. TYPE: 11. AGE/VINTAGE: 15. DISTILLED/PROD.BY: 16. ADDRESS: 17. BOTTLED BY: 18. ADDRESS: 19. SOLD UNDER ANY OTHER LABEL: 20. SHIP POINT: REASON FOR CHANGE: 23. 24. 25. AGE/VINTAGE/PROOF CHANGE SIZE CHANGE SCC/UPC CHANGE 26. 27. 28. CASE COST CHANGE VENDOR CHANGE NEW ITEM 3 LITER/ 4 LITER 1.75 LT/ 1.5 LT LITER 29. 30. 31. PALLET/TIER/WEIGHT CHANGE PACK CHANGE OTHER (Explain on Line 54) 375 ML/ 500 ML 200 ML/ 187 ML 50 ML/ 100 ML YES NO PROOF: AGE: EXPLAIN: 22. FRT. PER CWT: STATE CODE: 2. DATE SUBMITTED: 4. EFFECTIVE DATE: 7. SPECIAL PURCHASE ORDER PLAN: 10. FORMULA: 13. DOMESTIC: 14. IMPORTED: 14a INBOND: YES NO 6. BAILMENT: 9. CLASS: 12. PROOF/ALCOHOL: 21. FOB POINT: OTHER 32. UNIT PACK 33. OUNCES PER BOTTLE 34. BOTTLES / SLEEVE 35. VENDOR # - UPC(CO. - 6 DIGIT) - UPC (BRAND - 6 DIGIT) 36. 2ND VENDOR # - UPC (CO. - 6 DIGIT) 750 ML - UPC (BRAND - 6 DIGIT) 37. SHIP. CONT. CODE - SCC (first 8 digits) SHIP. CONT. CODE - SCC (last 6 digits) 38. STATE CODE 39. CASES / PALLET & CASES / LAYER 40. CASE WEIGHT (LBS) 41. NET COST FOB SHIP POINT 42. U.S. FREIGHT 43. OCEAN FREIGHT 44. MARINE INSURANCE 45. OTHER CHARGES / BAILMENT 46. DISCOUNT OR INSERT NET 47. TOTAL INVOICE COST 48. CASE DIMENSIONS (L/W/H) (INCHES) 49. BOTTLE DIMENSIONS (D/W/H) 50. LAST/PREVIOUS QUOTED COST 51. DATE LAST/PREVIOUS QUOTE 52. CASE COST INCREASE/DECREASE 53. COST PER SELLING UNIT 54. REMARKS: (INDICATE MI ADA) 55. Is this a product for which you want a limited listing period. 56. TERMS (NET/DISC.): 57. REPRESENTATIVE FOR THE STATE NAME: ADDRESS: LIC NO: TELEPHONE: FAX: YES NO If yes the listing ends / / 58. WE CERTIFY THAT THE FOREGOING IS CORRECT SUPPLIER: STATE LIC/PERMIT NO: FED. ID. NO.: ADDRESS: TELEPHONE: BY: TITLE: FAX: STATE USE American LegalNet, Inc. www.FormsWorkflow.com
