Have you or your organization bought from us before?
NAME:
PHONE 1:
PHONE 2:
FAX:
E-MAIL ADDRESS:
COMPANY:
Street:
City:
State:
ZIP/PC:
Country:
Date:


ITEMS ORDERED WITH PRICES: 


Please list the part names or numbers and the price below.
ITEM:..............................................PRICE:











SUBTOTAL: 

SHIPPING CHARGES: 
(See our FedEx rate schedule or leave 
blank and we will add shipping charges.) 

TOTAL CHARGES:

PAYMENT METHOD: 
We accept payment by university PO, government PO 
or Fed-Ex COD for cashier’s check or  money order. 
Make cashier's checks, money orders, university or 
government checks payable to NET EXPRESS. 

COMMENTS:

TRACKING NUMBER (We will supply):