LEHMAN SCIENTIFIC, LLC

ONLINE ORDER FORM

Voice: (800) 784-8680, (717) 244-7540, Fax: (717) 244-9524

Billing Address Shipping Address 
(if different from Ordering Address)

Name 

    

Company 

    

 Address 

    
   

City 

    

State/Province 

    

Postal Code 

    

Country 

    

Telephone Number 

  

Fax Number 

  

Email Address 

  
 

What are you ordering?
 Item Number  Item Name  Quantity  Cost Each

 How would you like this order shipped?
  UPS Ground- We will prepay and add shipping costs to your invoice (Default)
  UPS Ground- Collect (List your account number in "Special Instructions" below)
  UPS- Red (Overnight Service) For Collect- List your account number in "Special Instructions" below
  UPS- Blue (2nd Day Service) For Collect- List your account number in "Special Instructions" below
  UPS- Select (3rd Day Service) For Collect- List your account number in "Special Instructions" below
  Fed-Ex Express Collect (List your account number in "Special Instructions" below)
  US Postal Service

Note: Air Express services can be very expensive, please call for rates before specifying air services.

UPS and FedEx will not ship to a PO Box

Special shipping Instructions?

 

 Payment information:
 Account Type  

Account Name

Account Number

Account Expiration
 *Security Code*

Purchase Order # 
(If Applicable)

* American Express- 4-digit code on front of card

* Visa and MasterCard- 3-digit code on white strip on back of card

Notice to PA residents and business: 6% Pennsylvania Sales Tax will be added to the cost of the merchandise unless a PA Sales Tax Exemption Form is on file prior to shipment of the order.

 

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