Please fill out this form for ordering products online. All orders are FOB and net 30days.

We also accept VISA/MC. Please contact us or fax us with your credit card information.

Tel: 928-367-1200 | Fax: 928-367-1205

Please include your:

Name:
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Email:
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Telephone: **
Institution Name: **
Billing Address: **
Billing City, Sate, Country: **
Billing Zip: **
Shipping address: **
Shipping City, Sate, Country: **
Shipping Zip: **
Fax Number:
Purchase order number: **
Grant or Reference number:
Principal Investigator and/or contact person: **
Quantity(mg/mcgs) Cat# Description Unit Price (mg/mcg) Extension

*Shipping & handling on all U.S. orders, please add $30.00

International orders, please add $60.00 (U.S.)

All orders are FOB and Net 30 days!

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NanoLights | NanoFuels | NanoFluors

P.O. Box 2746 |   Pinetop, AZ 85935 |   (Phone) 928-367-1200 |   (Fax) 928-367-1205 | info@prolume.com