National Scientific - On-line Order Form   (Domestic Tubing & Rod Orders Only)

Name:         E-mail:  
Company/Organization:  
Phone:            FAX:  

Order or Reference Number:  

Shipping Address:                                               Billing Address (if different):
         
Shipping Attention:                                             Billing Attention:
               

Payment Method:  Visa MasterCard Open Account     Card Number: 
Expiration Date:      Name of Card holder: 

Ship by:  UPS Ground UPS-3 Day (Orange) UPS-2 Day (Blue) UPS Next Day (Red) FEDEX Express Saver FEDEX Second Day FEDEX Next Day - PM FEDEX Next Day - AM             Account Number: 
                        (Account number required for UPS Collect and all FEDEX shipments.)

Use this form for standard 48" (4-Ft) tubing and rod orders only. Call, fax or use our
Quote form for all non-standard or fabricated items. Click here to see a sample order.

QTY U/M Description Price

Note: Please observe our $50.00 minimum order.
Caution: Transmission of credit card information by use of this form is NOT secure.
                Send credit card number by two-part e-mail, call or fax if you prefer.
Use your "Print" button to save a copy for your records before submitting.

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