Ferret QuickChek™ ADV Antibody Test Order Form

 
Today’s Date
Name
Business Name, if applicable
Address
Apt. #
City
State
Zip/Postal Code
Country
Daytime Phone Number
Evening Phone Number
FAX
Email

 

Order Table

Product name
Price (ea)
Quantity
Total
QuikCheck ADV test (1 - 4 )
$15.00
QuikCheck ADV test (5 - 99)
$12.00
QuikCheck ADV test (100 - 199)
$11.15
QuikCheck ADV test (> 199)
$10.75
   
   
SUB-TOTAL
   
All Pennsylvania shipments
Add 6% sales tax
1-3 @ $3, 4-20 @ $5,
21-100 @ $8, >100 @ N/C		  
Shipping & Handling
   
TOTAL

Method of payment: (check your payment method below)

Invoice (Net 30)
Credit Card: (check one)
  
MC VISA Discover AMEX

 
Credit Card #
Expiration Date
Name on Card

 

Signature:_______________________________________


(When ordering by credit card, you must sign this form after printing and prior to faxing or mailing to Avecon.)


Thank you for your order. We look forward to helping you.

 

You can mail your order to:
 

Avecon Diagnostics, Incorporated
P.O. Box 8
501 Grouse Drive
Bath, Pennsylvania 18014
U.S.A.

 
Or FAX it to - 215-453-0714