CGC SCIENTIFIC, INC.

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
*	*

Shipping address

Catalog No.	Description	Regular pricing	Academic pricing
C210	CloneMap v2.11 for MS 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:
PO number is extremely important to ensure correct delivery, especially if the package goes through your receiving department first.
	Visa MasterCard
Card holder:	*
Card number:	*
Expiration date:	*
CVV number:	*
For Visa and MasterCard, the CVV number is the last 3 digit number located on the back of your card on or above your signature line.

Other contact:

Name:

Phone:

* Fax: * E-mail: *

Additional notes:

Add:	PO Box 83718,Gaithersburg,MD 20883-3718,USA
Tel:	301-767-0288
Fax:	301-767-0188 636-527-0419
Email:	cgc@cgcsci.com

Please send your questions or comments to cgc@cgcsci.com.