CGC Scientific, Inc. software product order form

Please fill out the following forms so that we have the complete information to process your order. If you prefer, you can also print out this form and fax it to us at (636) 527-0419.

Addresses:
Billing address Shipping address

Product:

Catalog No. Description Regular pricing Academic pricing
C210 CloneMap v2.11 for Windows $245.00 $195.00
M210 MacPlasmap v2.1 for Macintosh $195.00 $145.00
MP300 MacPlasmap Pro v3.01 for Macintosh $395.00 $295.00
UP300 Upgrade MacPlasmap v2.1 to MacPlasmap Pro v3.01 $295.00 $195.00

Shipping charge: $5.00 US & Canada, $10.00 elsewhere.

Number of copies:

Total cost ($US):

Payment information:

Purchase order (PO) number:

Visa MasterCard

Card number Expiration date

Card holder

Other contact:

Name:

Phone: Fax: E-mail:

Additional notes:

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    CGC Scientific, Inc.
    P.O. Box 354
    Ballwin, MO 63022
    (636) 527-0419 (fax)
    cgc@cgcsci.com (E-mail)
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