BioQuip Equipment Catalog - Nature | Where knowledge meets ...

ORDER FORM may be removed for use, or may be retained in catalog and photocopied as needed.
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Quantity Catalog No. Description Size/Color Unit price Dollars Cents
Minimum order: $25.00 for individuals; $35.00 for institutional orders. Total Merchandise
Minimum shipping/handling charge (U.S.): $8.00 Sales Tax (California only)
Notes: Estimated Shipping & Handling
METHOD OF PAYMENT:
G Check or Money OrdernAmount Enclosed
G Institution Purchase OrdernP.O. No.
G Credit Card No. Exp. Date
Card Holder Signature
ORDER FORM
PRODUCTS
Date:
BILL TO: Customer No. if known: SHIP TO: Use only if different from BILL TO
NAME NAME
STREET ADDRESS STREET ADDRESS
CITY STATE ZIP CITY STATE ZIP
COUNTRY COUNTRY
Signature Phone ( ) Email
Address:
2321 E. Gladwick Street
Rancho Dominguez, CA 90220 USA
Telephone: (310) 667-8800
Fax: (310) 667-8808
Email: bqinfo@bioquip.com
Web: www.bioquip.com
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