Fill out and fax this form to
1-302-292-8520
Purchase Order
No:
Date:
|
Ship to |
Bill to (Leave blank if the same as shipping): |
|
Name
Company
Address
City
State
Zip
Country
Phone |
Name
Company
Address
City
State
Zip
Country
Phone |
|
Prod_ID |
Description |
#of tubes |
Price |
Quantity |
Subtotal |
|
FT2002-20 |
FlashTubeTM 2002 with 2.0g of silica for
sample size 2-50mg |
20 |
$104 |
|
|
|
FT2002-100 |
100 |
$460 |
|
|
|
FTC-2 |
FlashTube cutter |
|
$20 |
|
|
|
Total: |
|
For bulk orders >500 FlashTubes please contact
us
Payment due: 30 days after invoice date. Shipping not included.
Shipping by UPS, Airborne, or FedEx.
Payment form (circle one): Check/Wire Transfer Visa/MC/AmEx/Discover
Card
number:
Expires:
Name on card:
Billing address:
|