www.researchpress.com Research Press Publishers Dept. 29W P.O. Box 9177 Champaign, Illinois 61826 U.S.A. Phone 217-352-3273 Fax 217-352-1221 E-Mail: rp@researchpress.com Today's Date: _______________________________ Ship to: Name: ____________________________________________________________________ Institution: _____________________________________________________________ Address: _________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ Country: _____________________________________ Daytime Phone: (_____) _______________________ Fax: (_____) _______________________ E-Mail: __________________________________________________________ Job Title: _____________________________________________________ Bill to or Credit Card Billing Address: (if different from above) Name: ____________________________________________________________________ Institution: _____________________________________________________________ Address: _________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ Country: _____________________________________ Daytime Phone: (_____) _______________________ Fax: (_____) _______________________ E-Mail: __________________________________________________________ Item Unit Item Number - Title Price - Quantity - Total ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ Materials Total _____________ NOTE: Prices are expressed in U.S. dollars, and payment must be made in U.S. dollars. Two Methods of Payment Available: 1. Credit Card – Provide credit card information below. Unless express mail delivery is requested (allow up to 5 days), orders are normally shipped by airmail (allow up to 10 days). Contact Research Press if you would like a price comparison of airmail and express mail delivery costs. 2. Pro Forma Invoice – After we receive your order, we will send you a pro forma invoice that will include the cost of your materials plus a comparison of shipping costs. You may choose airmail delivery (allow up to 10 days) or express mail (allow up to 5 days). Payment can be made by check in U.S. dollars drawn on a U.S. bank or by wire transfer to our bank. When we receive payment, we will ship your order promptly. Contact Research Press for details. Prices and terms are effective beginning August 1, 2008, and are subject to change without notice. Credit Card Orders Only Please specify method of delivery: ___ Airmail ____ Express Mail ___ Visa ____ MasterCard ___ Discover/Novus ___ American Express Exp. Date ______________ Name on Card ___________________________ Card No.________________________________ Phone No.(required)_________________________