Fax Order Form

FAX ORDER FORM

Please print and fill out this form and send or fax it to:

EnerGene Solutions for Molecular Biology
Taubengaesschen 1
D-93047 Regensburg
GERMANY

Fax-Number: +49 (941) 56 31 31

Customer # (if known):	__________________
Name:	__________________________________________
Company / Institute:	__________________________________________
Department:	__________________________________________
Street:	__________________________________________
City / ZIP:	__________________________________________
Country:	__________________________________________
Phone:	__________________________________________
Fax:	__________________________________________
E-mail:	__________________________________________

Items requested:

Quantity	Article		Catalog No.	Price (EURO)
x	NOWA	2 x 250 ml	W001 0250	79.00
x	Enlight	0.5 Lit.	R001 0500	59.00
x	Enlight	1.0 Lit.	R001 1000	99.00
x	Silver Surfer	40 mini gels	W003 0040	119.00
x	Snow White	25 mini gels	W002 0025	79.00
x	Deep Blue	0.5 Lit. (50 mini gels)	W004 0500	46.00
x	Deep Blue	1.0 Lit. (100 mini gels)	W004 1000	81.00
x	Bradford	500 ml	W005 0500	89.00
x	NuClean	400 TAE-prep.	N001 0400	89.00
x	NuClean II	400 TAE-, 275 TBE-prep.	N002 0400	95.00
x	pEG-His1	20 痢	V001 0020	179.00
x	GLOW	10 ml	M001 0010	79.00
x	T.Wax	500 beads	P001 0500	43.00