New Customer Sign-up If you are a first time customer and do not have a customer number, we ask that you sign up with us in an effort to simplify the order process and expedite future orders. Upon receiving your name and address information, we will add you to our files and issue you a Customer number via E-MAIL for future use.

CUSTOMER Information (Fields in dark red are required)		BILL TO Information (Information duplicated from above may be changed)
NAME:	Please use only principal investigator or lab supervisor name to obtain customer number. There will be a place for individual lab members on order form.	NAME:
DEPT, BLDG, RM#:		DEPT, BLDG, RM#:
INSTITUTION:		INSTITUTION:
STREET ADDRESS:		STREET ADDRESS:
CITY, STATE, ZIP:	,	CITY, STATE, ZIP:	,
COUNTRY:		COUNTRY:
PHONE:		PHONE:
FAX:		FAX:
E-MAIL ADDR:		E-MAIL ADDR:

Payment Information
PURCHASE ORDER NUMBER:
CREDIT CARD TYPE:	(None) Discover American Express Master Card Visa
CREDIT CARD NUMBER:	Expiration:

Home | Products | Order | Technical | Contact Us

---

Please direct all pricing inquiries to our Orders department.
For any other problems, please contact our WebMaster.