Order Form

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Order Form

To place an order, please complete the following form and click the SUBMIT button. You will need a valid quote number previously obtained from our Sales Department, or some other reference (verbal reference, eBay item number, etc.)

We accept payment by credit card (Visa, MasterCard, American Express) but we ask that you phone in or email us your number separately, since this form page is not on a secure server.

Reference or quote number *

Name *

Organization *

Phone Number *

Fax

Email *

Bill-to Address *

City *

State *

Postal Code *

Country

Ship-to Address *

(If same as bill-to, mark 'same') *

City *

State *

Postal Code *

Country

Price *

Taxable? (CA residents)

Material Ordered *

Purity *

Dimensions or Quantity *

Ordering a backing plate? (Y/N) *

If so, describe plate and bonding

Other Comments