Order Form

Company:	Order Date:
Address:	Phone#
	FAX#
City:	Postal Code:
State/province:	Country:
Purchase Order#	Email address:
Ship To (if different from above):	Bill to(if different from above)




Delivery Date Required:	FTIR Manufacturer and Model that PAC300 is to be used in:

Other Accessory Items to be ordered:

Name of Company Purchasing Authority

Terms: FOB Ames, Iowa USA.
Letter of Credit may be required for some non-domestic purchases. MTEC will respond to the purchaser if necessary.

Please print out completed form and FAX to: (515) 292-7125