Order Form

Please provide the following information in order for us to process
your request accurately:

QTY	MODEL #	BRIEF DESCRIPTION/SIZE/ETC.	UNIT PRICE

Please provide the address you would like the invoice to go to:

Name of Person Placing the Order
Title
Organization
Street Address
Address (cont.)
P.O. Box
City
State/Province
Zip/Postal Code
Country
Contact No.
FAX
E-mail

Please provide shipping address if different

Attention
Reference No.
Organization
Department
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code

Please select method of payment

Choose Method
Purchase Order #
Cardholder Name
Card Number
Security Code
Expiration Date	(mmyy)

How did you hear about us?

Once Form is Complete Click “File” “Save As” save the file to your desktop and then attach and send file to Info@braintreesci.com

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Copyright ©2001 Braintree Scientific, Inc.
Address: PO Box 361 Braintree, MA 02185
Phone: 781-348-0768 / FAX: 781-843-7932
e-mail: Info@braintreesci.com
Prices Subject to Change without Notice
Prices are Valid for U.S. Customers Only