DOES Institute Order form

Bill To: Ship To:  Check for same as Bill to
First Name First Name
Last Name Last Name
Company   Company  
Address 1 Address 1
Address 2 Address 2
City   City  
State Zip   State Zip  
Country Country

Phone FAX: Email address

Product 1 Item No. Product Name Price $ Quantity

Product 2 Item No. Product Name Price $ Quantity

Product 3 Item No. Product Name Price $ Quantity

Product 4 Item No. Product Name Price $ Quantity

Product 5 Item No. Product Name Price $ Quantity

 Method of Payment  Sub Total               $ 
Card Number Expiration Date *9% Shipping /Handling $
Purchase Order # Total                       $
Check Number  

For foreign orders - videotape format  
Please note any special order information:

*Current Protocols shipping is listed in the price sheet:
All orders from outside the United States and Canada must be prepaid in U.S. currency or credit card before an order can be shipped.  Please contact DOES Institute for Bank transfer information. Shipping costs may be higher for foreign orders.