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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
Billing Information
Company Name
Attention To
Email Address
Address
City
Province
Select province
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland & Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Other/US State
Postal Code
Phone
PO#/AFE#
Billing Notes
Shipping Information
Ship to Different Address
Ship to Billing Address
Greyhound Shipping
Pick Up
Company Name
Attention To
Email Address
Address
City
Province
Select province
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland & Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Other/US State
Postal Code
Phone
Ship Date
no pref
5:00AM
6:00AM
7:00AM
8:00AM
9:00AM
10:00AM
11:00AM
12:00PM
1:00PM
2:00PM
3:00PM
4:00PM
5:00PM
6:00PM
7:00PM
I need same day shipping
Shipping Notes
Wellsite Information
Well Name
Province
Select province
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland & Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Other/US State
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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