<p> ADDA USA Sample Request Form 1150 W. Central Ave. # C, Brea, CA 92821 Phone: (714) 674-7921, Fax: (714) 257-7486</p><p>Requested By: (Company) Date Requested: </p><p>Contact Person: Email:</p><p>Tel: Fax:</p><p>Address: State: Zip Code: </p><p>ADDA Model No. / Qty. / @Price / Potential / Shipping Date Required / / / / / / / / / / / / / / / / / / / / / / / / / / / /</p><p>Data Sheet Requested:  YES  NO Safety Sheets Requested: YES NO</p><p>Shipping Information: Shipping Address:</p><p>City: State: Zip Code:</p><p>Tel: ( ) - Fax: ( ) -</p><p>Ship By: UPS RED Blue Orange Regular Account #:</p><p>Fed Ex: Priority Overnight Standard Overnight Fed Ex 2 dayAccount #:</p><p>Other: (Please Specify)</p><p>Customer or End-User Information: Company: Contact: Project Name: Address: City: State: Zip Code:</p><p>Tel: Fax:</p><p>Please Fax Back to: ADDA USA (714) 257–7486</p><p>Approved By ADDA USA (For ADDA USA Only) Name: Date: Scheduled Shipping Date: ADDA USA Ref. No. Comments:</p>