Orderform PASH Standards 


Prof. Dr. Jan T. Andersson

Institute of Analytical and Inorganic Chemistry
Corrensstr. 30

D-48149 Münster

Phone: ++49-251-83-33141; Fax:++49-251-83-36013     Date: ____________

Sender

Company:___________________________________________

Street:___________________________________________

Zip Code/City: _________________________________________

Country:___________________________________________

Phone:___________________________________________

Fax:___________________________________________

No. CAS-No. No. of Ampouls Name of Standard Net Amount (DM)
1        
2        
3        
4        
5        
6        
7        
8        
9        
10        
11        
12        
13        
14        
15        
16        
      Sum:   
      ___ % Discount:   
Express Delivery? yes no  Total Net Amount:   

Stamp /Signature

________________________________