Quote-to-Order Form

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Quote-to-Order Form

Order Info

* Order Info
- I have received a formal quote, and I wish to order and pay online with a credit card.
- I have received my order number with the total order charge, and I wish to pay online with a credit card.
* Order Number
* Quote#/Project#
* Order Total
* Upload Purchase Order Document

* Upload Credit Card Authorization Form

Download authorization form

Credit Card Info

* Credit Card Type

* Name on Card

* Credit Card Number

* Expiry Date

* CVV Number

Purchaser Info

* Purchaser Name

* Email

* Phone

Ship To

* Attention

Email

* Phone
* Company/Institute
* Shipping Address

address, city, state/province, zip/post code, country

Bill To

Bill to
- Same as Ship To
Attention

Email

Phone
Company/Institute
Billing Address

address, city, state/province, zip/post code, country
Shipping Method
- Best way (via FedEx or UPS): Biomatik will determine the best and most cost effective shipping method. The Shipping & Handling cost will be the same as the quoted cost.
- via FedEx: We will inform you and get your approval if the Shipping & Handling cost is higher than the quoted cost.
- via UPS: We will inform you and get your approval if the Shipping & Handling cost is higher than the quoted cost.
- Use your own courier account: Please indicate the courier name and account number in the Comments box below.

Comments

Comments
* Acknowledge
- I approve that all the requirements have been fully and correctly specified in the quotation. I acknowledge and accept the terms and conditions as set out in the quotation.

* Required Fields

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