Benchmark Catalog Order Form

phone: (609) 397 1131       fax: (609) 397 1159       email: ask a t benchmarkcatalog d o t com 
Please be sure to include a way to reach you !   We will email or fax a confirmation of receipt of order.
If you do not hear from us directly, be sure to contact us.  Your fax may not have gone through.

 Ship to.................                                                                                                                                               

 Tax ID or V.A.T. number (if applicable)
 Your Name                                                                                                                                                                                       
 Institution                          
 Address  (cannot ship to Postal Boxes)                                   
 
 
 
 City  City Postal Code (if applicable)
 State  Zip Code (if applicable)
 Country (if other than US)  Country Postal Code (if applicable)

 Phone:

 Fax:

 Email:

 Check one:  MasterCard ❏    VISA ❏    Amex ❏                   Security Codes: 3 digit for M/C & Visa (on back of card),   4 digit for Amex (on front of card)

 Card #
Sec. Code:                               Exp. Date:

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Comments?

 Merchandise Total (not including S/H)   
Shipping / Handling    we calculate this per order
Total  

We normally ship UPS Ground. Note here if you need special shipping:

Check if residential ❏