Order Form

This order form is for domestic orders only.
International orders please fax your order & information to our sales office (1-724-282-0745) or call us direct at (1-724-282-7145).

  1. Please provide the following contact information:

    BILLING
    Name
    Title
    Organization
    Street Address
    Address (cont.)
    City
    State/Province
    Zip/Postal Code
    Country
    Work Phone
    FAX
    E-mail
       

  2. Please provide a good ship to address (No P.O. Boxes, or Rural Routes):

    SHIPPING
    Contact Name
    Dept. Name
    Organization
    Street Address
    Address (cont.)
    City
    State/Province
    Zip/Postal Code
    Country
    Phone
     

  3. Please provide the following ordering information:

    QTY ITEM NUMBER DESCRIPTION

  4. Type of Payment?

    Purchase Order Other

    BILLING
    Purchase Order #
    Credit Card


    We do not currently accept credit cards on this form. For credit card sales please submit this form without credit card information then contact us via phone 1-877-LIVE-CELL (1-877-548-3235) or 724-282-7145 at a minimum of 30 minutes after submission of this form. Hours of business operation are 9am-5pm eastern time. Current ET time:

Bioptechs Inc.
All rights reserved.
Revised: 11/13/02 

 [Home] [Products] [Price list]  E-mail:info@bioptechs.com
Phone: (724) 282-7145, Toll-Free 877 LIVE-CELL (5483-2355), Fax: (724) 282-0745