Please complete the following form to place your order. Our sales team will contact you to confirm and process your order. Please note that fields marked with * are required.
Please see the Orders page for more details on the ordering process.
If you only require more information on our products and services, please use the Contact Form or email us directly at

Part 1: Your Information

First and Last Name* Organization

E-mail* Phone Number*

Part 2: Your Order

To place order for more 3 products, please email us at
Select the product* Select the amount* Amount (in mg)
if ≥1.0mg
Select an additional product Select the amount Amount (in mg)  
if ≥1.0mg

Part 3: Shipping Address

Street Address*
Address Line 2
State / Province / Region*
Postal / Zip Code* Country / Area*

Part 4: Billing Address

Please fill out this section if your billing address is different than your shipping address.
Street Address
Address Line 2
City State / Province / Region
Postal / Zip Code Country / Area

Part 5: Purchase Order Form & Other Forms

Please attach your purchase order form and any other forms (e.g.: Import License, etc) if available.
Upload your purchase order form Upload other forms
Please upload forms in:
.PDF, .DOC, .DOCX, and .RTF file formats.
Please e-mail any additional forms to

Part 6: Preferred Form of Payment

You do not need to enter any payment information here, only state your preferred method of payment.
Select your preferred form of payment*
Credit Card    
Mail-in Check    
Wire Transfer    
Other (see next)    
Other payment method
For example, if your organization uses third-party supplier to make purchases for you.

Part 7: Shipping Service Information

Please provide us with your shipping company and account if available.
Name of shipping service Other shipping service Shipping service account number

Part 8: Comments & Questions

Comments and Questions