Today's Date: _______________________________


Ship to:

Name: ____________________________________________________________________

Institution: _____________________________________________________________

Address: _________________________________________________________________

City: _____________________________________  State: ___  ZIP: ____________

Above is: __ Work Address     __ Home Address

Daytime Phone: (_____) _______________________

Fax: (_____) _______________________

E-Mail: __________________________________________________________

Job Title: _____________________________________________________



Bill to or Credit Card Billing Address: (if different from above)

Name: ____________________________________________________________________

Institution: _____________________________________________________________

Address: _________________________________________________________________

City: _____________________________________  State: ___  ZIP: ____________

Daytime Phone: (_____) _______________________

Fax: (_____) _______________________

E-Mail: __________________________________________________________

Tax Exempt Illinois customers enter your exemption number_________________



Item                                                Unit               Item
Number - Title		                            Price - Quantity - Total
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                                              Materials Total _____________

                                        *Shipping and Handling _____________

*If your Materials Total is:
$1.00 to $59.99 add $6.00
$60.00 to $499.99 add 10%
$500.00 to $1,999.99 add 8%
$2,000.00 to $2,499.99 add 6%
$2,500.00 or more add 4%

                                                     Subtotal _____________

         Illinois customers add 6.5% sales tax unless exempt _____________

                                                        TOTAL _____________

NOTE: Prices and terms are effective beginning January 1, 2008, and are
subject to change without notice.

Method of Payment

___ Check or organizational purchase order enclosed.

Organizational Purchase Order No._______________________

___ Visa    ____ MasterCard     ___ Discover/Novus     ___ American Express

Exp. Date ______________  Name on Card ___________________________________

Card No.____________________________________ 

Phone No.(required)____________________________