ORDERing

Information

PHONE

949-269-3260

EMAIL

metabiologics@objectpharma.com

FAX

608-441-2731

Ordering Instructions:

To assist us in expediting your order, please provide the following information:

Email address
Purchase order number
Shipping address
Billing address
Size, quantity and name of each product ordered
Legitimate Needs Form (below)

NEW CUSTOMERS

Order Form New Customer

NAME

First Name

Last Name

COMPANY NAME

PURCHASE ORDER NUMBER

PRODUCT INFORMATION

Product 1

Amount (μg)

product 1

Product 2

Amount (μg)

product 2

Product 3

Amount (μg)

product 3

Product 4

Amount (μg)

product 4

To add more than four items, please type the additional catalog number(s), product(s), serotype(s), and amount(s) below.

Additional information or comments (i.e. buffer specification, aliquoting scheme, shipper number, etc.).

SHIPPING ADDRESS

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Recipient Company Name and Contact Info

Company Name, Contact, Email, Phone Number

BILLING ADDRESS

Leave blank if previous address is the same

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Tax ID/EIN

Tax Exemption Number

Send a copy to info@metabiologics.com If outside of USA, please disregard

Billing Company Name and Contact Info

Company Name, Contact, Email, Phone Number

Existing Customers

Order Form Existing Customer

NAME

First Name

Last Name

COMPANY NAME

PURCHASE ORDER NUMBER

PRODUCT INFORMATION

Product 1

Amount (μg)

product 1

Product 2

Amount (μg)

product 2

Product 3

Amount (μg)

product 3

Product 4

Amount (μg)

product 4

To add more than four items, please type the additional catalog number(s), product(s), serotype(s), and amount(s) below.

Additional information or comments (i.e. buffer specification, aliquoting scheme, shipper number, etc.).

Please fill out Legitimate Needs Form and email it to metabiologics@objectpharma.com

If order is larger than 1 mg, then please fill out CDC Form 2

Terms: Net 30 days. Shipping F.O.B. Madison, Wisconsin USA. Large orders require a 25% non-refundable deposit.

Please Note: All products sold by Metabiologics are intended FOR RESEARCH USE ONLY. CDC registration is required for all customers in the United States and an Export Certificate is required for all customers outside the United States.