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ORDER FORM
FOR MTEC PHOTOACOUSTICS PRODUCTS

Company: Order Date:
Address: Phone#
             FAX#
City: Postal Code:
State/province: Country:
Purchase Order# Email address:
Ship to Address: Bill to (if different from Ship to Address)
Delivery Date Required: FTIR Manufacturer and Model that PAC300 is to be used in:

Other Accessory Items to be ordered:

Part# Price (US$) Quantity Description
Name of Company Purchasing Authority:

Terms: FOB Ames, Iowa USA.
Letter of Credit may be required for some non-domestic purchases.   MTEC will respond to the purchaser if necessary.

Either print out the COMPLETED form and FAX it to: 1-515- 292-7974 OR save it as .pdf and Email it to mtec@mtecpas.com