Mailable/Faxable Order Form  
Billing Information
First Name: _____________________
Last Name:  
Address:  
City:  
State:  
Zip:  
Phone:  
Email:  
Shipping Information
First Name: _____________________
Last Name:  
Address:  
City:  
State:  
Zip:  
Phone:  
Email:  
1. Paying By Check


 Check Number:__________
2. Paying By Credit Card
(Circle one)
VISA
MASTERCARD
DISCOVER
CC Number:____________________________Expiration:__________
Signature:__________
Quantity Item No. Product Pkg. Price Item Total
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Standard Shipping Charges:  
Subtotal:  
(8.5% Illinios, 5.6% Wisconsin)  Tax:  
Total:  
  1. Please print this form and mail or fax it to us.
    1. Include a check with check number. (Make check payable to labwarehouse.com.)
    2. Include your credit card information and signature
  2. Sales tax only applies if order is shipped to an address in Illinois
  3. Shipping outside of the contiguous 48 states? Shipping Info to get your shipping options


MAILING ADDRESS:
labwarehouse.com
P.O. Box 1030
Skokie, IL 60076
FAX NUMBER: 800 / 934-0722
Standard Shipping Charges
Merchandise Total S & H Fee
Up to $15.00 $5.95
$15.01 to $30.00 $6.95
$30.01 to $50.00 $8.95
$50.01 to $70.00 $10.95
$70.01 to $100.00 $12.95
$100.01 to $200.00 $15.95
$200.01 and Up $18.95