HTML Preview Office Order page number 1.
Please return this form to Fatima Adams for processing
DATE
YOUR NAME PHONE NUMBER
EMAIL ADDRESS SPEEDTYPE
VENDOR NAME VENDOR PHONE #
LAB AFFILIATION
Item #
QTY.
ITEM NAME
DESCRIPTION
COST
SUBTOTAL --------
SHIPPING/HANDLING $
TOTAL
COMMENTS:
ORDER PLACED BY:____________ DATE:_______________
____ NEXT DAY ____ 2-DAY ____5-7 BUSINESS DAYS
____ VISA PURCHASE ____ INTERNET ____ PHONE
Means of Shipment: □ FedEx □ UPS □ Airborne □ US Mail □
Overnight
□ 2
nd
Day □ 5-7 Working Days □ Ground Transportation