Our on-line ordering form is easy to use, simply complete the form and press Submit. We will respond electronically with an order confirmation, or a status update within 24 hours. Should you have any additional comments there are room for those at the end.

Customer Information

Please provide either your CSI Customer Number or your Bill To and Ship To addresses (if you don’t know your Customer Number, it will be given to you while this order is being processed, use it in the future to save time):

NOTE: Fields marked with an asterisk (*) are required.

Customer Number:

		Bill To:	Ship To:
	*Company
	*Address
	*City
	*Province	Default Alberta British Columbia Manitoba New Brunswick Newfoundland Northwest Territories Nova Scotia Ontario Prince Edward Island Quebec Saskatchewan Yukon	Default Alberta British Columbia Manitoba New Brunswick Newfoundland Northwest Territories Nova Scotia Ontario Prince Edward Island Quebec Saskatchewan Yukon
	*Postal Code
	*Attention
	*Name
	*Phone
	*Fax
	*Email

Federal Financial Administration

*Are you a Federal Government Department or Agency (does the Federal Financial Administration Act apply to you)?
Yes No

*If you have answered YES above. Is this order a CALL UP against a STANDING OFFER?
Yes No

*CALL UP number:

Order Information

*CSI Part Number:     *Quantity:     Description:
*CSI Part Number:     *Quantity:     Description:
*CSI Part Number:     *Quantity:     Description:
*CSI Part Number:     *Quantity:     Description:
*CSI Part Number:     *Quantity:     Description:
*CSI Part Number:     *Quantity:     Description:
*CSI Part Number:     *Quantity:     Description:
*CSI Part Number:     *Quantity:     Description:
*CSI Part Number:     *Quantity:     Description:
*CSI Part Number:     *Quantity:     Description:
*CSI Part Number:     *Quantity:     Description:
*CSI Part Number:     *Quantity:     Description:

* If the CSI Part Number is unknown, please provide the current supplier's name, their part number, and a brief description of the item(s). If you are unsure, contact our Technical Support Department at 1-800-267-8103 or tech@chromspec.com for assistance.

*Payment Method

Use P.O. #
Credit Card (On file at CSI)
Credit Card is not on file**

Please specify a value.

** note: this is not a secure line; do not include your credit card information with the order. If you are paying by credit card but the information is not on file at our office, simply call our Order Desk at 1-800-267-8103, and provide the card number and expiry date. Let us know if you want us to keep the information on file for future orders.

Taxes

Check the boxes of the applicable taxes that your company is to be charged:

PST HST GST BC Social Service Tax

Shipping

Purolator Prepaid and charged on your invoice is our default shipping method. We can also ship Purolator Collect; simply provide us your freight account. For non-Purolator shipments, we require your preferred carrier's name and your account number. These will always ship collect.

Preferred Carrier:
Account Number (if other than Purolator, Prepaid):

Rush Ship Complete Please specify a value.

Ground Air Please specify a value.

Thank you for submitting this order. Chromatographic Specialties Inc. will respond to you electronically with the following information: CSI Customer Number, stock information , pricing information, reference number, and freight information

Additional Comments