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Adaptas

Order Form

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Adaptas Scientific Instrument Services

9 Second Street
Palmer, MA 01069
(413) 284-9975
Fax: (413) 284-9979
https://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 $40.00. Orders under $40.00 will be accessed a handling fee to $40.00.

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.