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* Name:
* Mailing Address: (NOTE: We must have a street address for standard FedEx shipping)
* Phone Number:
Alternate number (fax/mobile):
* Email Address:
Enter your purchase order number, if you have one:
* Please use the space below to describe the information or strains that you need:
Use the space below for any special instructions (e.g. a different invoice address). Non-US clients, please enter your VAT or tax exempt number. Indicate the source of funding for your research and the name of the Principal Investigator.
NOTE : Do not send payment information on this form.
* Check the box below to indicate that you agree to the following terms:

All orders are to be pre-paid, or accompanied by an institutional purchase order.

 

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