Benchmark Catalog Order Form

phone: (609) 397 1131       fax: (609) 397 1159       email: ask a t benchmarkcatalog d o t com 
                                                                                                                               (make this into the standard email format to mail us)
Please be sure to include a way to reach you !!

 Ship to.................                                                                                                   Check if residential ❏
 Your Name                                                                                                     
 Institution 
 Address  (cannot ship to Postal Boxes)                                     Tax ID or V.A.T. number (ifapplicable)
 
 
 
 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 ❏

 Card #
 Expiration Date

Item # Qty. Description Price Per Ext
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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: