Order Form

Please complete this form to place an order using a PO.

Alternatively you can send your PO to orders@fuse-dx.com.

Please note shipping is FREE in the UK only.

If you order from outside the UK you are responsible for the cost of shipping and import duties.

If you are a new customer we will get in touch ahead of shipping your order.

Name

First Name

Last Name

Organisation

Phone

(###)

###

####

Select the Products you would like to Order

Flip Mycoplasma

Yes

Flip Mycoplasma External Positive Control

Yes

PO Number

Shipping Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Is the Billing Address the same as the Shipping Address?

Yes

Thank you for your Order!