BIOGENICS
09359 Highway 126
MAPLETON, OREGON 97453 USA
(541) 268-2004
(541) 268-4757 FAX

COLOSTROMETER™ ORDER FORM

**SHIPPING SPECIAL**
Buy two Retail Colostrometers™ and get free shipping (within USA)
DESCRIPTION QTY UNIT PRICE SHIPPING & HANDLING/EACH
Colostrometer™ Only
Colostrometer™ plus Shipping/Measuring Cylinders
Private Label (Free)
Colostrometer™ with Jar
Private Label (Free)
Only Jar
Total Cost 
BILLING
* Credit Card:
* Cardholder Name:
* Credit Card Billing Address:
* City:
* State:
* Zip Code:
* Card number:
* Expiration Date (mmyy):
SHIPPING
* Street Address:
Address (continued):
* City:
* State:
* Zip Code:
* Country:
CONTACT INFORMATION:
* Full Name:
Title:
Organization:
Street Address:
Address (continued):
City:
State / Province:
Zip / Postal Code:
Country:
* Work Phone:
Home Phone:
FAX:
* E-Mail:
Website Address:

If you prefer to send your order by FAX, print the completed order form and FAX to:
Biogenics
FAX: (541) 268-4757


If paying by check: print and mail this completed form, along with your check, to: Biogenics
09359 Highway 126
Mapleton, Oregon, 97453 U.S.A.
Telephone: (541) 268-2004


Note: Personal or Business Checks must clear before merchandise ships.