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FEEL FREE TO PLACE AN ORDER by completing the order form below:
GENERAL INFORMATION

Company Name:
*
Person Placing Order:
*
E-Mail Address:
*
* Required
Telephone:
P.O. # (If Required):


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BILLING INFORMATION

My Ship To address and my Bill To address are the same.


Bill To:

Address:
City:
State:
Zip Code:
Ship To:

Address:
City:
State:
Zip Code:


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CHEMICAL ORDERS

Product
Tote
55 Gal.
30 Gal.
15 Gal.
5 Gal.
Sample

NOTE: Tote orders will arrive in 220 to 330 gallon quantities, depending on the product ordered. All orders will be shipped and billed in pounds.

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REAGENT ORDERS

Reagent (Product Number or Description) Quantity


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EQUIPMENT ORDERS

Equipment (Product Number or Description) Quantity


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TECHNICAL SERVICE VISITS

Please call me to schedule a technical service visit.


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QUESTIONS ON PLACING ORDERS

If you need help placing your order, please submit your question below:



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