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1273 rue Saint-Louis, Terrebonne, Québec, Canada, J6W 1K6
Tél. 1.800.361.1502 450.471.1379 Fax. 450.471.1030
www.instrumentarium-online.com [email protected]
BILL TO : SHIP TO :
(IF DIFFERENT)
TELEPHONE : FAX :
EMAIL : PO #:
ID # : DATE :
ORDER : QUOTATION:
QTY # CAT. DESCRIPTION UNIT PRICE TOTAL
TRANSPORT AND HANDLING FEES ARE NOT INCLUDED :
PAYMENT : CASH VISA MASTER CARD ARE ACCEPTED :
Print name
CARD # : EXPIRED DATE :
Card holder signature
CHECK ENCLOSED, MADE PAYABLE TO INSTRUMENTARIUM
COMMENTS :
