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New technologies for detection and prevention of prion diseases

Online Order Form

click here for Printable (Microsoft Word) version of this form

Customer Information

Purchasing Company or Institution Name
D-Gen Credit A/c reference number
VAT Registration No.
Contact Name
Invoice Address
Postcode / Zip Code
Country
Telephone No.
Fax No.
Email Address
Nature of Business
Mode of Payment

Product Order Details

Purchase Order No.
Delivery Address

Product Code	Product ref	Pack Size	Unit Price (£)	Quantity	Total Price (£)
0130-00301	ICSM-3	100µg
0130-00310	ICSM-3	1 mg
0130-00401	ICSM-4	100µg
0130-00410	ICSM-4	1 mg
0130-01001	ICSM-10	100µg
0130-01010	ICSM-10	1mg
0130-01501	ICSM-15	100µg
0130-01510	ICSM-15	1mg
0130-01801	ICSM-18	100µg
0130-01810	ICSM-18	1mg
0130-03501	ICSM-35	100µg
0130-03510	ICSM-35	1mg
			Sub Total
			Academic Discount*
		UK Customers please tick this box	VAT	@ 17.5%
			Total	£

I confirm that I have seen and agree with the D-Gen Terms and Conditions of Business.

Please Note:

(i) Delivery charges are included in the prices quoted above.
(ii) For overseas customers if an import license is required for importation from the UK into your country please send us a copy of this by fax/post if possible. We will include this with the goods to speed up customs clearance.
(iii) If you are paying by either Cheque or Bankers draft then please print this page (File menu -->print) BEFORE submitting this form. You will need to send a paper copy of the order together with your cheque or bankers draft.
(iv) No contract for the purchase of any goods will be formed until D-Gen has issued a written confirmation of order acceptance.

Comments & Special Instructions (ie.For example: without sodium azide preservative, import license being faxed etc.) :

* A 5% discount applies to orders from those in the academic community

Links

	Purchase Order Form
	Credit Account Application Form
	Order Online
	Price List
	Terms and Conditions



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