Sales Order Form

ASC Scientific
2075 Corte del Nogal, Suite T
Carlsbad, CA  USA  92011

Tel.  (800) 272-4327 or (760) 431-2655
Fax.  (760) 431-0904
sales@ascscientific.com

 

Payment Options:

[  ] MasterCard

[  ] VISA

[  ] American Express

[  ] Check

Card Number: ___________________________ Expiration Date: ____ / ____    Security Code:______

Name on Card:__________________________________ Tel. Number: ______________________

email address:__________________________________  Fax Number:  _____________________

Ship To:

_____________________________________

_____________________________________

_____________________________________

_____________________________________

_____________________________________

Card Billing Address: (if different)

_____________________________________

_____________________________________

_____________________________________

_____________________________________

_____________________________________

 

Shipping Method:

[ ] UPS Ground

[ ] UPS 3rd Day

[ ] UPS 2nd Day

[ ] UPS Next Day

[ ] International FedEx

 Items you would like to order:

Catalog #

Description

Price Each

Quantity

Total Price

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

We will contact you with confirmation of prices, shipping cost and any applicable Calif. Sales Tax.