Please fax to: 608-260-8192 to Attention of Sales

Purchase Order#_____________________________ Date______________

VISA Mastercard (Please circle one) Card # _________________________________

Name as it appears on card: _________________________________ Exp. Date: ____________

How did you hear about Neoclone?_________________________________

P.I. Name:____________________________________________________

E-Mail:_______________________________ Phone:__________________

Billing Address :

Name______________________________________

Department_________________________________ Institution___________________________________

Street______________________________________

City______________________State_______ Zip____________

Phone#_________________________ E-Mail address_______________________________

Shipping Address (if different):

Name______________________________________

Department_________________________________ Institution___________________________________

Street______________________________________

City_______________________ State_______ Zip____________

Contact phone#_________________________ Contact E-Mail Address________________________

Item(s) Ordered:

NeoClone antibodies and products may not be resold or modified for resale without prior written approval.

Shipping: Lyophilized: NeoClone ships via Federal Express and determines actual shipping costs based on a Federal Express quote for your shipment.
Ordering Questions: 608-260-8190
Technical Questions: 608-260-8191