SPECIAL ORDER
WO RKSHEET
RETU RN TO FAX NO. 542-1072
To:_________________________Fax:_______________________
SPECIAL ORDER WORKSHEET
CAMPUS SCIENTIFIC STORES
CUSTOMER INFORMATION:
Customer Name:________________________________________________________
Customer ID No:________________________________________________________
Customer Account No:___________________________________________________
Telephone:_______________________________ Fax:_________________________
PRODUCT INFORMATION: (U SE B ACK S IDE FOR A DDITIONAL ITEMS)
Source (vendor):_______________________________________________________
Description:___________________________________________________________
Mfg. Name & Catalog Number:____________________________________________
Unit of Issue (Packa ging: i.e . 25 0g, 10 0m l, 10 0ul):__________________________________
Quantity Needed (of the above units of issue ):________________________________________
0.00
_____________ X _________________ = _______________ (This line MUST be completed)
Quantity
Unit of Issue Price
Extended Total
Estimate
Estimate
Please reference vendors catalog page number if available:_____________________
Delivery Request:
~ OVERNIGHT ~ 2
ND
DAY
~ GROUND
I agree to be responsible for any restocking and/or shipping charges which may be
incurred for the return of any material I may have ordered incorrectly.
Additionally, in the event the supplier refused to accept the return of the material, I
agree to its full acceptance for payment purposes.
_______________________________________________
Signature
Date