Transcription of Order Form Back - api-pt.com
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Order Form Back - api-pt.com
Send orders and payments to: Department 9526, Box 30516, Lansing, MI 48909-8016 800-333-0958 Fax: NumberHCO #LAP/CAP #COLA #API # (if applicable)___ ___ D ___ ___ ___ ___ ___ ___ ___Shipping InformationBilling InformationShipping ContactBilling ContactInstitution NameInstitution NameDepartmentDepartmentStreet Address (products cannot be shipped to a Box)Mailing AddressAddress 2 Address 2 CityStateZipCityStateZipPhone/Fax:Phone/ Fax:Email:Email:Send copies of reports to: (a copy will also be sent to the address above)Send additional copies of reports to: (attach a list if more than two)AttentionAttentionInstitution Name and AddressInstitution Name and AddressCityStateZipCityStateZipPhone/Fax :Phone/Fax:Email:Email:Quantity Unit PriceTotal$$ $$ $$ $$ $$ $$ $$ $$ $$ $$ $$ $$ $$ $$ $$ $$ $$ $$ *Additional
All products and prices listed apply to domestic orders only. Contact API for product availability and pricing for international requests. CHEMISTRY HEMATOLOGY & COAGULATION (continued) MICROBIOLOGY (continued)
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