Orderform PASH Standards 

Prof. Dr. Jan T. Andersson

Institute of Analytical and Inorganic Chemistry
Corrensstr. 36

D-48149 Münster, Germany 

Phone: ++49-251-83-33102; Fax:++49-251-83-36013     Date: ____________

Sender

Name:______________________________________________

Address:___________________________________________

___________________________________________________

___________________________________________________

Country:___________________________________________

Phone:_____________________________________________

Fax:_______________________________________________

No. CAS-No. No. of Ampouls Name of Standard Net Amount (Euro)
1        
2        
3        
4        
5        
6        
7        
8        
9        
10        
11        
12        
13        
14        
15        
      Sum:   
      ___ % Discount:   
  Total Net Amount:   

Stamp /Signature

________________________________