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Instructions
Print this form, then fill in your address and payment information in the space
provided and fax or mail it to us at:
SCIENCE KIT & BOREAL LABORATORIES Order Toll-Free
PO BOX 5003 -- 777 EAST PARK DRIVE Phone: 800-828-7777 Fax: 800-828-3299
TONAWANDA, NY 14151-5003
http://www.sciencekit.com
PURCHASE ORDER FORM FOR DATE: 7/6/2008
www.sciencekit.com
BILL TO: SHIP TO:
____________________________________ ____________________________________
Name Name
____________________________________ ____________________________________
Company Company
____________________________________ ____________________________________
Street Address Street Address (Do not use a PO Box)
____________________________________ ____________________________________
Street Address (line 2) Street Address (line 2)
____________________________________ ____________________________________
Street Address (line 3) Street Address (line 3)
____________________________________ ____________________________________
City State ZIP City State ZIP
____________________________________ ____________________________________
Country Country
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Phone Ext. Phone Ext.
____________________________________ ____________________________________
Fax Fax
____________________________________ ____________________________________
E-mail E-mail
PAYMENT:
_____ Check Enclosed: $_________________ (Make Payable to Science Kit)
_____ Credit Card: ___VISA ___MasterCard
Credit Card Number: |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|
Card Security Code: ________________
Expiration Date: ____/____
Name on Card: ________________________________________________________
Signature: ___________________________________________________________
Shipping Method (if other than Standard): ___Next Day
Please tell us why you chose the print/fax option instead of completing this order
online with a credit card:
__________________________________________________________________________________
__________________________________________________________________________________
THANK YOU FOR ORDERING FROM SCIENCE KIT
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