Place an Order - SciOptic Canada

SciOptic Canada - Bags & Vials Order Form v4

Phone:1-877-264-8037 - Fax:(403)717-9737 - Email: scioptic@shaw.ca - Unit #13 1916 30th Ave NE, Calgary, AB, T2E 7B2

Warning: When filling in this form, please be mindful to proceed with the order and form submit process as soon as possible. Web browsers and websites have a timeout/session mechanism, if you leave the form unattended too long, the data you have filled in will reset. Try to finalize the order within 15 minutes.

Billing Information
Company Name
Attention To
Email Address
Address
City		Province
Postal Code		Phone
PO#/AFE#
Billing Notes

Shipping Information
Company Name
Attention To
Email Address
Address
City	Province
Postal Code	Phone
Ship Date		I need same day shipping
Shipping Notes

Wellsite Information
Well Name		Province
Well ID/LSD		License #

I need the following (check that apply):

Sample Bags Trays & Vials Labels (No Vials) EZ Sample Files

Sample Bags
Size: 4x6 5x7 8x11
Style: Blank Printed Lined Lined & Printed
Depth		Interval	Office Use
From	To
From	To
From	To
I need Gunny Sacks : Qty

Trays & Vials
I need Trays & Vials for:
Company Government Both Company & Government
Depth		Interval	Office Use
From	To
From	To
From	To
I need Bulk Tray (No Labels) : Qty

Note: Labels are included when ordering your Vials & Trays Labels (No Vials)
I need Company Government Both Company & Government
Depth		Interval	Office Use
From	To
From	To
From	To

EZ Sample Files
Qty Large:		Qty Small:
Depth			Interval	Office Use
From	To
From	To
From	To

Special Instructions

Office Use
Vials	___________	___________	Labels	___________	___________	Bags	___________
Blanks	___________	___________	Trays	___________	___________	Blanks	___________
EZ Files	___________	Small ___________ Large ___________			___________	Gunny	___________

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