Purchase/ Order

Order Form
(print this page to order by fax/mail)

All prices in U.S. Dollars.
All shipments FOB Medford, NY

telephone:	(917) 853-6440
fax:	(212) 937-3801
e-mail:	help@salv.com
mail:	2294 Nostrand Avenue, Brooklyn, NY 11210 USA

FOR DISTRIBUTORS ONLY
Order	Quote Only
Contact Name:
Billing Address:
Shipping Address:
Phone Number:
Fax Number:
Email Address:
comments
PO#:

specify quantity of product of interest

Product Quantity

Hema Strip HIV

Stat Simple Pylori

Sero Strip HIV

Omni-SAL

Omni SWAB

Saliva Sampler

Saliva Filter

Saliva Strip HIV

For International Orders Please specify shipment method: DHL Collect: FedEx International: Airborne: other: Acct Number: Check off mode you would like to receive confirmation by: Phone: Fax: E-Mail:

Telephone orders do not require written confirmation. Written order confirmation must be clearly marked, otherwise charges for duplicate shipments will be customer’s responsibility.

SHIPPING:
Within the USA: All shipments F.O.B. Cambridge, MA. Shipping and handling charges are prepaid and added to the invoice.
Outside the USA: Orders for delivery must be prepaid in U.S. dollars. Prepayment must include shipping and handling charges. Contact us for your local foreign distributor.

PAYMENT:
Invoices are payable in U.S. dollars, Net 30 upon approval of account. A late fee of 1.5% per month, 18% per year will be charged. Prices subject to change without notice. MasterCard and Visa accepted.