Order Form

Full Name of Person Placing Order:  Date (mm/dd/yyyy):
Phone Number, Including Area Code:Purchase Order No.
Email address:Date Your Order is Needed*:
Name of Researcher:Researcher Phone Number:
Name of Billing Contact:Billing Contact Phone Number:
Fax Number:Special Instructions:

To pay by   or American Express please enter the following:VisaMasterCardAm. Exp.
Credit Card No.: Expiration Date (mm/year):

              *PLEASE ALLOW TEN (10) BUSINESS DAYS FOR THE PREPARATION AND SHIPMENT OF YOUR ORDER.

Shipping Address:

Please be sure to include Attention line, Department, Floor or Room if any. Note UPS will not deliver to a P. O. Box.

Institution Name: Attention Line:
Street Address Line 1:
Street Address Line 2:  
City: State: Select a State International Alabama Alaska Arizona Arkansas California Colorado Connecticut Deleware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming CountryZip Code:

Special Instructions:

Billing Address:

Please be sure to include Attention line, Department, Floor or Room if any.

Institution Name: Attention Line:
Street Address Line 1:
Street Address Line 2:
City: State:  Select a State International Alabama Alaska Arizona Arkansas California Colorado Connecticut Deleware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming CountryZip Code:

Special Instructions:

Items Ordered:

(Diet # refers to 6-digit catalog number) (Choose Unit of Measure) (Click on Pellets or Powder form for Diet entries)

1) Diet # Description:
    Quantity:        Choose One Each:  Kg Liters Grams      Choose Form: Pellets Powder

2) Diet # Description:
    Quantity:        Choose One Each:  Kg Liters Grams       Choose Form: Pellets Powder

3) Diet # Description:
     Quantity:       Choose One Each:  Kg Liters Grams       Choose Form: Pellets Powder

4) Diet # Description:
     Quantity:       Choose One Each:  Kg Liters Grams        Choose Form: Pellets Powder

5) Diet # Description:
     Quantity:       Choose One Each:  Kg Liters Grams        Choose Form: Pellets Powder

     To order more than 5 items, first send your order with the first 5 items. Then click on BACK in your web
     browser. Enter the additional items and delete the previous ones. Keep all pertinent information such as
     ship-to addresses, bill-to address, P.O.#, contact name, and E-mail address the same and click on SEND
     ORDER. We will send you an order confirmation by E-mail.