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Microscopes
America, Inc.® 6340 Hampton Highlands Drive, Cumming, GA. 30041-4095 Toll Free: 1-800-790-8115 or 1-904-347-1011 Fax: 1-770-889-6253 Web: www.MicroscopesAmerica.com e-mail: info@microscopesamerica.com |
Order Form
Please, print this Order Form, fill in the information
in the space provided and fax it or mail it to us.
Mail to: 
Microscopes America, Inc. 6340 Hampton
Highlands Drive, Cumming, GA 30041
Or: Fax to: 
1-770-889-6253
Date: _______/______/_______
My Name Is:_______________________________________________________________________________
My Schools Name / Institution: _________________________________________________________________
My Title Is: ______________________________________My Department Is: ___________________________
This Order Will Be Shipped To:_________________________________________________________________
Street Address: ________________________________________________________ City: ________________
State: _________________________________________Zip code: ____________________________________
Telephone#: ________________________________________Fax Number: _____________________________
E-mail:____________________________________________________________________________________
Payment Will Be Made By PURCHASE ORDER: # _________________________________________________
Payment Will Be Made By Check Enclosed: $_________________ (Make Payable to: Microscopes America, Inc.)
Payment Will Be Made By CREDIT OR DEBIT CARD: Visa MasterCard Discover
Card Number: # |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__| Expiration date: _________/___________
Name on Card:______________________________________________Card Security Code: ________________
Note: (This option is available if you prefer not send your credit card information over the internet)
Quantity Ordered |
Order Number |
Model Number |
Brief Description |
Unit Price |
Total |
Subtotal: $______________________
(In GA., and not tax-exempt?) Add 5% Tax (If Applicable): __________________
Microscopes America Pays for Shipping: NO CHARGE
Grand Total: $ __________________