$125.00

$130.00

$47.00

$75.00

6-$240.00

12-$480.00

$30.00

6-$264.00

12-$528.00

$22.00

$40.00

$44.00

$80.00

$33.00

$22.00

$84.00

$94.00

$25.00

$42.00

FOB Memphis

Surface Delivery

Surface Delivery

FOB Memphis

Surface Delivery

FOB Memphis

Surface Delivery

FOB Memphis

Surface Delivery

FOB Memphis

Surface Delivery

FOB Memphis

FOB Memphis

Surface Delivery

 

 

 

 

 

 

 

 

 

FOB Memphis

REPRODUCE LOCALLY FORM APPROVED – OMB NO. 0581-0008

UNITED STATES DEPARTMENT OF AGRICULTURE

AGRICULTURAL MARKETING SERVICE

COTTON AND TOBACCO PROGRAM

DATE: ORDER #

Standardization & Engineering Division

3275 Appling Rd.

Memphis, TN 38133

Telephone: (901) 384-3030

Fax: (901) 384-3032

E-mail: cotton.standards@usda.gov

DO NOT WRITE IN THIS SPACE

 PAID BY CHECK NO. AMOUNT

 RECEIVED BY DATE

HVI Color and Trash Calibration Standard Order Form

ITEM U.S. EXPORT QUANTITY DOLLAR

AMOUNT

L1

L3

L4

L5

L6

M1

M2

M3

M4

Calibration Color Tile Set - 5 Tiles

(Xenon)

Calibration Color Tile Set - Single Tile

W B Y G C

Color Check Box

(6 assorted cottons)

Universal HVI Cotton Color Standard 

(12 assorted cottons)

Reassignment of Calibration Color Tile Set

Trash Tile (1)

(Xenon)

Cotton Images Under Glass

(6 Trash Levels)

(12 Trash Levels)

Single Cotton Image Under Glass

(Check One)

1 2 3 4 5 6

Leaf Guide Book (Check Type)

American Upland

Request Quote for 

Air Freight Pre-Paid

FOB Memphis Request Quote for 

Air Freight Pre-Paid

Request Quote for 

Air Freight Pre-Paid

Request Quote for 

Air Freight Pre-Paid

FOB Memphis Request Quote for 

Surface Delivery Air Freight Pre-Paid

Request Quote for 

Air Freight Pre-Paid

Request Quote for 

Air Freight Pre-Paid

Request Quote for 

Air Freight Pre-Paid

Request Quote for 

Surface Delivery $25.00 Air Freight Pre-Paid

$

M5 Tile Storage Box (Check Type)

Color Tile Box Cotton Under Glass Box .

FOB Memphis $50.00 Request Quote for 

Surface Delivery $50.00 Air Freight Pre-Paid

Totals $

PAYMENT MUST BE SUBMITTED WITH ORDER. WE DO NOT ACCEPT LETTERS OF CREDIT.

CHECK MUST BE DRAWN ON A U.S. BANK PAYABLE TO : USDA, AMS, COTTON AND TOBACCO PROGRAM.

MC ACCT. NO. EXPIRES SIGNATURE

PRICES: Price of standards includes packaging, handling and delivery where stated. Fumigation (if needed) is a minimum of $135.00 per order.

Phytosanitary Certificate (if needed) is $65.00.

CHECK VISA

SHIP TO (print or type) 

CONTACT NAME COMPANY NAME

STREET ADDRESS (necessary) POSTAL BOX CITY

STATE, COUNTRY, AND ZIP CODE E-MAIL ADDRESS PHONE FAX

CN-383-D (3-2017 Expires 3-31-2024) (Previous editions are to be destroyed)
 

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to 

respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for 

this information collection is 0581-0008. The time required to complete this information collection is estimated to average 4 

minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and 

maintaining the data needed, and completing and reviewing the collection of information. 

In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, 

the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are 

prohibited from discriminating based on race, color, national origin, religion, sex, gender identity 

(including gender expression), sexual orientation, disability, age, marital status, family/parental status, income derived from a 

public assistance program, political beliefs, or reprisal or retaliation for prior civil rights activity, in any program or activity 

conducted or funded by USDA (not all bases apply to all programs). Remedies and complaint filing deadlines vary by 

program or incident. 

Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large print, 

audiotape, American Sign Language, etc.) should contact the responsible Agency or USDA’s TARGET Center at (202) 

720-2600 (voice and TTY) or contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program

information may be made available in languages other than English. To file a program discrimination complaint, complete

the USDA Program Discrimination Complaint Form, AD-3027, found online at http://www.ascr.usda.gov/

complaint_filing_cust.html and at any USDA office or write a letter addressed to USDA and provide in the letter all of the

information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed

form or letter to USDA by: (1) mail: U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights 1400

Independence Avenue, SW Washington, D.C. 20250-9410; (2) fax: (202) 690-7442; or (3) email: program.intake@usda.gov.

USDA is an equal opportunity provider, employer, and lender.

CN-383-D (3-2017 Expires 3-31-2024) (Previous editions are to be destroyed)