ANALYTIC LAB ACCESSORIES
Disposables for Bioresearch and Robotic Systems

ALA TIPS.COM ORDER FORM

PURCHASE ORDER NUMBER:        

CONTACT PERSON:                        

TELEPHONE NUMBER:                   

EMAIL:                                      

BILL TO:                                                                                                                              

    ADDRESS LINE 1                                                  

    ADDRESS LINE 2                                                

    ADDRESS LINE 3                                                  

    ADDRESS LINE 4                                             

    ADDRESS LINE 5                                          

 SHIP TO:

    ADDRESS LINE 1

    ADDRESS LINE 2

     ADDRESS LINE 3

    ADDRESS LINE 4

    ADDRESS LINE 5

QUANTITY                 CATALOG                          DESCRIPTION                      UNIT PRICE                        TOTAL

                                   NUMBER

QUANTITY                 CATALOG                          DESCRIPTION                      UNIT PRICE                        TOTAL

                                   NUMBER

QUANTITY                 CATALOG                          DESCRIPTION                      UNIT PRICE                        TOTAL

                                   NUMBER

QUANTITY                 CATALOG                          DESCRIPTION                      UNIT PRICE                        TOTAL

                                   NUMBER

QUANTITY                 CATALOG                          DESCRIPTION                      UNIT PRICE                        TOTAL

                                   NUMBER

QUANTITY                 CATALOG                          DESCRIPTION                      UNIT PRICE                        TOTAL

                                   NUMBER

                                                                                                                           GRAND TOTAL                    

TERMS:  NET 30 DAYS, FOB ORIGIN

WE ALSO ACCEPT MASTERCARD AND VISA! CALL US FOR DETAILS!

ANALYTIC LAB ACCESSORIES

P.O. BOX 345

ROCKVILLE CENTRE, NY 11571-0345

EMAIL: mail@alatips.com

CALL:  1-800-735-1721

FAX:  1-516-678-8021