Immunochemistry Invoice Template

ADVERTISEMENT

800-829-3194 fax 952-888-8988
ICT Sales Rep:
Date:
Person placing the order:
PO # or payment method:
Name; Dept/Title:
(enter credit card info at bottom):
End-User’s Name; Title;
Shipping Address:
Billing Address:
Dept; Address; City; State; Zip;
Organization; Dept; Address; City; State; Zip; Country;
Country; Phone; Fax:
Phone; Fax; Email:
Attention line and phone # for the package:
Shipping options
:
circle one
Add shipping charges to invoice
Use my shipping account; here’s the carrier and my
account #:
Have you ordered from ICT before?
How did you hear about ICT’s products?
Catalog
Product Description
Size
Quantity
Unit Price
Total price
Number
Offer
code
Subtotal
Sales Tax (only in MN) / Duties (only Foreign)
Shipping & Handling ($30-40 US; ~$70 Canada; $100 international)
Approximate Total
For credit card orders, please fill out the information below:
circle one:
Visa / MasterCard / AmEx / Discover # __ __ __ __ - __ __ __ __ - __ __ __ __ - __ __ __ __
Expiration __ __ / __ __ month/year
Security code__ __ __ __ (3 or 4 digits; printed on card)
Name on the card: __________________________ Signature: ____________________________
Address to which the bill is sent: ____________________________________________________
Would you like the charge receipt: in the box / faxed / mailed?
082606sah

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Business
Go