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If Hach account
number is not
Use this convenient form, your own purchase orders, or for PROMPT PHONE SERVICE
known, leave the
CALL 1-800-227-4224. If ordering by phone, please have information related to items 1 - 4
space blank.
(below) ready.
Most chemicals and
Check box if "Ship To" information is identical to "Bill To".
apparatus are sold
separately ("each"),
but others are sold in
units. Powder
B
pillows, for
I
example, are
L
available in
L
packages of 100. To
purchase 100
powder pillows,
T
order 1 unit, not 100
O
pillows. Be sure to
order the number of
units (packages) you
need.
S
Include all numbers
H
given in the products
I
listing.
P
A one- or two-word
description of the
T
item.
O
If more than one size
of an item is offered,
PAYMENT METHOD:
state the size you
want.
___________________________
Card Account or Purchase Order No.
Unless otherwise
instructed, Hach will
choose the best and
most efficient mode
QUANTIT
of transportation and
calculate the
amount.
Check one box. Tax
exempt status must
be substantiated with
documentation
identifying your tax
exempt number. If
taxable, sales tax
will be added.
MAIL ORDER FORM
HACH
COMPANY, P.O. Box 608, Loveland, CO 80539-0608
COMPANY
DIVISION
OF
ADDRESS
CITY
ATTENTION
PHONE NO. ( ___________)
COMPANY
DIVISION
OF
ADDRESS
CITY
ATTENTION
HACH ACCOUNT NO. (If available)
CAT. NO.
Y
STATE
________________________ EXTENSION
STATE
Check
MasterCard
____________
Card Exp. Date
DESCRIPTION
ZIP
___________
ZIP
Visa
Purchase Order
___________________________
Signature
UNIT
UNIT
SIZE
PRICE
TOTAL
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