National Scientific - On-line Order Form

(Domestic Tubing & Rod Orders Only)

Name First Last
Email
Company/Organization
Phone - (###) - ### ####
Fax - (###) - ### ####
Order / Reference #
Shipping Address
Shipping Attention
Billing Address
Billing Attention
Card Type
Card Number
Cardholder Name
Card Expiration Date / MM YYYY
Ship By
Account Number
(Account number required for UPS Collect and all FEDEX shipments.)
Account number required for UPS Collect and all FEDEX shipments.
Order Specifications
Use this form for standard 48" (4-Ft) tubing and rod orders only. Call, fax or use our Quote form for all non-standard or fabricated items. Click here to see a sample order. QTY U/M Description Price

Note: Please observe our $50.00 minimum order.
Caution:
Transmission of credit card information by use of this form is NOT secure. Send credit card number by two-part e-mail, call or fax if you prefer.
Use your "Print" button to save a copy for your records before submitting.
Caution:
reset button clears all fields. Return to main page.