To submit this form, please complete all editable fields , print this form and FAX it to us at 281.870.1279. Alternatively, you can print this form out and complete it by hand.
To: MetaLab Inc.
Ship to:
Attention:
Address: 14355 Schiller Road
Address:
City, State, Zip: Houston, TX, 77082
City, State, Zip:
Phone: 281-870-1014
Phone:
Date
Date required
Terms
How shipped
Req. number or Dept.
For
Item description
Price
Quantity
Total
PractiCAM™ software set (including the annual maintenance program for the first year)
$ 19,995.00
PractiCAD™ software set (including the annual maintenance program for the first year)
$ 9,995.00
Discount (code: )
Total
Important
Purchase order number must appear on all invoices, packaging, etc.
Please notify us immediately if you are unable to complete the order by the specified date.
Please send copies of your invoice with the original bill of lading.
Authorized purchasing agent:
Terms and Conditions
Submited by:
Tax ID (or SSN):
Address:
City, State, Zip:
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