(Please print or type)
| BILLED TO: | SHIPPED TO: (if different) |
| Customer Name: _________________________ | Customer Name: _________________________ |
| Company: _______________________________ | Company: _______________________________ |
| Address: ________________________________ | Address: ________________________________ |
| City, State _______________________________ | City, State _______________________________ |
| Zip Code: _______________________________ | Zip Code: _______________________________ |
| Telephone: _____________________________ | Telephone: _____________________________ |
| Fax: ___________________________________ | Fax: ___________________________________ |
| Email: __________________________________ | Email: __________________________________ |
|
Product |
Price per Copy * |
Number of Copies |
Total |
|
MIL-HDBK-23A Structural Sandwich Composites |
$100.00 |
* Regular US Mail Shipping and Handling Included
PA Sales Tax if
Applicable: ________________
Total Amount of
Purchase: $ ________________
Method of Payment:
_______ Purchase Order # _________________________
_______ Enclosed Check (payable to Materials Sciences Corporation)
_______ Credit
Card (circle one)
VISA MasterCard American Express
Card Number: _________________________________________________
Card Expiration Date: _________________________________________________
Name of Cardholder:
_________________________________________________
I, the undersigned, authorize Materials Sciences
Corporation to charge my credit card for the total amount of purchase stated
above.
________________________________________________________________
Signature Date
Print page, then Mail or FAX orders to: Materials Sciences Corporation, 181 Gibraltar Road, Horsham, PA, 19044, Tel: (215) 542-8400, FAX: (215) 542-8401. Email: handbook@materials-sciences.com