Arbor Assays Order Form Outside the US? Go to our "distributor” page. Recipient InformationReturning customer? You can enter your Customer ID, Name of End User and Email Address and skip to the payment section.Customer IDIf you know your Customer ID number, enter it here. If you are a new customer, or if you do not know your Customer ID, simply leave this field blank.Name of End User*InstitutionDepartmentAddress* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Please visit our distributors page if ordering from outside the U.S.PhoneFaxEmail* Buyer InformationBuyer Name* First Last Email* Phone*Shipment DetailsDate Needed ByNote: Due to a continued volume surge with both FedEx and UPS, if something is time-critical please consider requesting overnight service. Although this can be more expensive, those packages are given priority over other services. Date Format: MM slash DD slash YYYY Shipping PreferenceArbor Assays account (we will determine best, most economical service)Customer Courier AccountCourier NamePlease note if using FedEx or UPSShipping Account NumberOrder DetailsProducts*Click the + button to add additional products.Catalog NumberProduct NameQuantityPrice Each Quote#/Promotion CodeIf you have a quote number or promotion code associated with your order, please enter it here.Would you like to add an order note or special instructions? Yes Notes/Special InstructionsAre you a new customer? Yes How did you learn about Arbor Assays?PaymentPayment Method*Note: If you would like to order using a Purchase Order (PO) and you are a new customer, we require a Credit Application to be filled out and sent back to us to keep on file. If you are unsure if a Credit Application is on file for your account, please contact [email protected] for assistance with your order.Credit CardPOTo download a copy of our credit application please go to: Downloadable Credit Application -Purchase Order Information(If including a separate PO document, please email to [email protected] or fax to 734-677-6860.)Purchase Order #Bill To InstitutionBilling Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Billing Contact Name* First Last Billing Phone Number*Billing Fax NumberBilling Email* Terms & ConditionsTerms & Conditions*To continue, you must agree to Arbor Assays' terms & conditions. I Agree CommentsThis field is for validation purposes and should be left unchanged.