Catalog No.                   Manufacturer            Listed Price      QTY
    Please select brand Acculab A&D Adam Algen Scale Alleghany AmCells Bel Cardinal CAS CCi Chatillion Denver Instruments Detecto DIGI Doran Evergreen First Weigh General GSE Health-O-Meter Hydroscale Intercomp Inscale Ohaus Pelouze Rice Lake Salter Sartorius Seca Setra Shekel SR Instruments Tanita Tri-Coastal UWE Weightronix not sure    $       

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 Company:           
 Ship to Address: 
                           
 City:                    St.: Zip: -
 Phone:                   Fax:
 Email:  

 Payment Method: VISA Master Card American Express Discover Purchase Order C.O.D.      P.O. #:

 If paying by Credit Card, please complete the following:

 Name on Card:   Expiration: Month Jan Feb March April May June July Aug Sept Oct Nov Dec   Year 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
 Card No.:         (no spaces or hyphens)
 Security Code:   (last 3 digits)

 Address Credit Card Bill is mailed to:
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Please enter address where your credit card bill is mailed if different from above: 
 

Additional comments: 
 

A confirmation by phone, fax or email will made for any charges to your account. 
For questions or to order by phone, please call 800-836-8445 or  631-342-1975.
To fax your order, please print out this form and fax to 631-342-1977.

Thank you. We appreciate your business.

We accept these Credit Cards: