Online Order Form

Customer Information
Please provide either your Biolynx 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
  *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)?


Order Information
*Part Number:     *Quantity:     Description:
*Part Number:     *Quantity:     Description:
*Part Number:     *Quantity:     Description:
*Part Number:     *Quantity:     Description:
*Part Number:     *Quantity:     Description:
*Part Number:     *Quantity:     Description:
*Part Number:     *Quantity:     Description:
*Part Number:     *Quantity:     Description:
*Part Number:     *Quantity:     Description:
*Part Number:     *Quantity:     Description:
*Part Number:     *Quantity:     Description:
*Part Number:     *Quantity:     Description:



*Payment Method



Valid Please specify a value.
Card Holder Name:
Credit Card Number:
Expiry Date:



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):

Please verify all information is correct before placing your order.

Additional Comments

 
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