PTX Food Corp - Food Ingredient Specialists

Product Samples Online Order Form

We are pleased to provide you with sample quantities for testing of our products. Please complete the form below and click the "submit" button to place your order. [You may also download a "print and fax" order form here.]

QUESTIONS regarding submitting this from?:
Contact Bob Patti, PTX Food Corp., Phone: 1-262-271-0904 eMail: rpatti@ptxfoodcorp.com

	My PTX Broker/Distributor is:
	I do not have a PTX Broker/Distributor
Who is making this request?:
I am (check one):*	an existing customer [PTX customer number: ]
	a new user considering PTX products
	a PTX Broker/Distributor:
	a PTX Employee:
Ship samples to:
Attention:*
Company Name:*
SHIP TO Address:* [NO P.O. Boxes]
City / State / Zip:*
To arrive on or before [Date]:*	[MM-DD-YYYY]
Shipping info:	NOTE: your sample request will be filled on the second business day after receipt of this order form and will be shipped by UPS GROUND unless otherwise specified. Need sooner? Please explain: OR
	provide your shipping carrier:
	and shipping account number:
	Next Day early AM Next Day 2nd Day 3-Day Ground
Customer contact information:
My Name:*
Company Name:*
Company Mailing Address:*
City / State / Zip:
My Phone Number:*	Include Area Code: ext.
My Fax Number:	Include Area Code:
My eMail Address:*
I would like to receive the PTX product eMail newsletter.
I would like a PTX representative to contact me regarding specific applications using PTX ingredients.
Special Instructions:

I am requesting sample quantities of the following product(s): Please check products requested, indicated quantiy required of each product you are ordering.

		35 CAP — Natural Mold Inhibitor for baked goods (contains dairy and wheat). Quantity: 4 oz. sample 8 oz. sample Large qty. lbs.
		35 CAP-F — Natural Mold Inhibitor for baked goods and other food items (all dairy). Quantity: 4 oz. sample 8 oz. sample Large qty. lbs.
		Acidifier — Use to reduce pH. Quantity: 4 oz. sample 8 oz. sample Large qty. lbs.
		Better Dressing 3X — Liquid, bland tasting, natural vinegar replacer. Quantity: 4 oz. sample 8 oz. sample Large qty. lbs.
		Better Dressing Dry** — Vinegar Replacer/Neutral Flavor Quantity: 4 oz. sample 8 oz. sample Large qty. lbs.
		CAP 35 F Mold Inhibitor** — Natural/100% Dairy No Wheat Quantity: 4 oz. sample 8 oz. sample Large qty. lbs.
		CAPARVE 350 B — Natural Mold Inhibitor for baked goods. Quantity: 4 oz. sample 8 oz. sample Large qty. lbs.
		CAPARVE 350 F — Natural Mold Inhibitor for baked goods as well as other food products. Quantity: 4 oz. sample 8 oz. sample Large qty. lbs.
		Cheese Enhance K-100** — For Cost Reduction/Aged Cheese/Flavor Enhancer/Best In Dry Cheese Blends. Quantity: 4 oz. sample 8 oz. sample Large qty. lbs.
		Confidant — Natural preservative for both g+ & g- bacteria, yeast and mold. Quantity: 4 oz. sample 8 oz. sample Large qty. lbs.
		Flavor Enhancer PHD** — Vegetable Base/Savory/None Unammi/Meaty Flavor/High Heat Compatible Quantity: 4 oz. sample 8 oz. sample Large qty. lbs.
		Flavor Enhancer PM** — Vegetable Base/Savory/None Unammi/Rich Mouth Feel Quantity: 4 oz. sample 8 oz. sample Large qty. lbs.
		Flavor Whey-SW40** — Natural All Purpose Savory Flavor Enhancer (also replaces MSG) Quantity: 4 oz. sample 8 oz. sample Large qty. lbs.
		Flavor Whey-SW40 Beef R001** — Savory Flavor Enhancer/Beef Broth Quantity: 4 oz. sample 8 oz. sample Large qty. lbs.
		Flavor Whey-SW40 Beef R003** — Savory Flavor Enhancer/Roasted Beef Quantity: 4 oz. sample 8 oz. sample Large qty. lbs.
		Flavor Whey-SW40 Parmesan Concentrate** — Flavor Enhancer/Also Used In Cheddar Cheese Quantity: 4 oz. sample 8 oz. sample Large qty. lbs.
		Intense-2 — All purpose flavor enhancer - umami Quantity: 4 oz. sample 8 oz. sample Large qty. lbs.
		Prevent — Natural preservative for or g+ bacteria, yeast & mold. Quantity: 4 oz. sample 8 oz. sample Large qty. lbs.
		PTX Complete** — Inulin/FOS/Natural Soluble Fiber Quantity: 4 oz. sample 8 oz. sample Large qty. lbs.
		Roasted Chicken Skin Flavor** —Signature Flavor Enhancer Quantity: 4 oz. sample 8 oz. sample Large qty. lbs.
		Salt Eliminator Potato** — Sodium Reduction/savory/Cheese Flavor Enhancement Quantity: 4 oz. sample 8 oz. sample Large qty. lbs.
		Salt Eliminator Tomato** — Sodium Reduction/Marinara Tomato Sauce (not for sweet tomato sauce) Quantity: 4 oz. sample 8 oz. sample Large qty. lbs.
		Salt Enhancer N100** — For Salt Reduction/Flavor Enhancement Quantity: 4 oz. sample 8 oz. sample Large qty. lbs.
		Salt Enhancer N200** — Dairy Free For Salt Reduction/Flavor Enhancement Quantity: 4 oz. sample 8 oz. sample Large qty. lbs.
		Salt Enhancer N300 — Svory salt and flavor enhancer Quantity: 4 oz. sample 8 oz. sample Large qty. lbs.
		Soup Extender B-Savory** — For Cost Reduction in Sauces, Soups, Condiments, Meat and Other Savory Products Quantity: 4 oz. sample 8 oz. sample Large qty. lbs.
		Other: Quantity: 4 oz. sample 8 oz. sample Large qty. lbs.

	Order a SAMPLE BOX of all 16 products with above (4 oz. of each) $50.00 including shipping** [please check billing option below]
	number of sample boxes requested
	Bill me at the address above
	I am requesting that this $50.00 charge be WAIVED. I understand that I will be contacted by a PTX representative to determine eligibility.

The product samples requested will be used in what application?:*
sauces meats frozen foods baked goods dairy beverages other:
Your authorization:* Please type in your FULL name to authorize this sample product request. Orders will NOT be shipped without it.

Date: [MM-DD-YYYY] *
*Required Fields