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