printable order form

( Print this page, fill-out by hand, and send by fax or mail )

Scientific Instrument Services, Inc.

1027 Old York Road
Ringoes, New Jersey 08551-1039
(908) 788-5550
Fax: (908) 806-6631
http://www.sisweb.com

Order Form

Date:_____________

SOLD TO:

SHIP TO:

Method of Payment (select one)

SIS Account
Account Number_________________________
Credit Card (select one) __ American Express __ Visa __ MasterCard
Card Number:_______________
Expiration Date:______________
Credit Card Billing Name:_______________
COD

Purchase Order #:_____________________________
Name:______________________________________
Phone:_____________________________________
E-Mail:____________________________________

Minimum order $25.00. Orders under $25.00 will be accessed a $10.00 handling fee

Part #	Description	Unit Price	Quantity	totals












subtotal =
Tax =
Shipping charges =
Other charges =
Total =

Additional Comments:

ALL CLAIMS FOR ERRORS OR SHORTAGES MUST BE MADE WITHIN 10 DAYS AFTER RECEIPT OF GOODS. NO GOODS MAY BE RETURNED WITHOUT PERMISSION.

TERMS-NET 30 DAYS. A SERVICE CHARGE OF 1 1/2 PER MONTH (18% PER ANNUM) WILL BE CHARGED ON ALL PAST DUE ACCOUNTS.

Name/organization:
Email:		Phone/fax: