Please use this form to prepare your order. You may print this form and fill it out, or fill it out on screen, then print and send to us.

Name

Address  

City   State     Postal Code

Country

Telephone    Email

Please check your selection(s) and indicate quantity:

TRICS for Written Communication
      $60.00 (US) x Quantity   =

ETCH Test Kit (New)
     $150.00 (US) x Quantity   =

ETCH Test Kit (Used)
     $85.00 (US) x Quantity   =

+ shipping (US: $7.00 TRICS, $12.50 ETCH; International: 12% in Canada; 20% for all other countries)

Total: $

Payment:  Check or Money Order    Purchase Order

Credit Card     VISA       MasterCard

Name on Card   Card Number

Expiration Date    Signature

  Please print and send orders to: