Thank you
for choosing Tima Scientific. Print this form from within your browser, fill
it out, and fax it to (902)
475-3399.
Please PRINT, clearly.
You will receive confirmation by e-mail, stating the total price of your order,
including the price of shipping.
To Print: From the menu at the top of your browser, select "File," then, choose "Print",
First Name: _______________________________ Last Name: ____________________________________ Institution/Organization/Agency: _____________________________________________________________ Shipping Address: _______________________________________________________________________ City: ___________________________________________________________________________________ State/Province: __________________________________________________________________________ Zip/Postal Code: ________________________________________ Country: _________________________ Is the Billing Address the same as the Shipping Address? If not, please, enter Billing Address: Street: _________________________________________________________________________________ City: ___________________________________________________________________________________ State/Province: __________________________________________________________________________ Zip/Postal Code: ________________________________________ Country _________________________ Phone Number: ___________________________________________ (include area code) Fax Number: _____________________________________________ (include area code) E-Mail Address: ___________________________@____________________________________________ Digital device used: ________________________________________ (e.g., PDA, Palmtop, Digital Camera, etc.) Make and Model of Device: ________________________________________________________________ Method of Payment: ______Visa ______ MC ______ AMEX______ Check______ Money Order Credit Card Number: ______________________________________________ Expiry Date: ___________ Please enter the product(s) you would like to purchase: Product ID: ________________Item: _____________________________Price: $___________ QTY: _____ Product ID: ________________Item: _____________________________Price: $___________ QTY: _____ Product ID: ________________Item: _____________________________Price: $___________ QTY: _____ Comments: _____________________________________________________________________________ ________________________________________________________________________________________ |
Print and fax to: (902) 475-3399
Return To: TimaTech Main Page