Term USAOrder Form
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Please fill in the form and submit it online, or print it and fax or send by mail, using the contact information at the bottom of the page.

Date  
BILLING ADDRESS: SHIPPING ADDRESS:
(if different from billing)
Name Name
Street Address Street Address
   
City City
State State
Zip/Country Code Zip/Country Code
Country Country
Phone Phone
Fax Fax
E-mail E-mail
P.O. Number
ITEMS TO ORDER:
*Please designate item and purity
Item    Quantity    Price Per    Subtotal  
Item    Quantity    Price Per    Subtotal  
Item    Quantity    Price Per    Subtotal  
Item    Quantity    Price Per    Subtotal  
Item    Quantity    Price Per    Subtotal  

Your order, with Tax (if applicable) and Shipping and Handling added, will be confirmed by fax or email. Orders are typically filled in one to six weeks.



Payment (US$) should be made by check to:
Term USA
18875 Trillium Lane
Fort Bragg, California 95437
USA
fax: 707-964-7974

Or by wire transfer of US$ to the account of:
Term USA (account #01295-01820) in
Bank of America (aba bank routing #026-009-593)

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