Secure Online Order Form
Order Information
Item # Model # Quantity
1
2
3
4
5
6
7
 
Customer Information
Billing Information First Name*
Last Name*
Company*
Address line 1*
Address line 2
City*
State or province*
Postal or zip code*
Country*
 Use the same information for shipping and billing.
Shipping Information First Name
Last Name
Company
Address line 1
Address line 2
City
State or province
Postal or zip code
Country
Contact information Telephone*
Fax
E-mail*
Order information Purchase order number
Required date*
Shipping method
Payment Method
Open Account
Customers with established Sensoray credit may order under an open account.
Non-open account orders may use a credit card, bank transfer of funds or apply for open account.
Credit Card
SSL Certificate Authority
SSL Certificate Authority
Credit Card Number*
We do not accept American Express
Expiration Date (MM/YY)*
Cardholder Name*
Submit Order

All orders ship within 48 hours or we will notify you of delays.

Please note: Sensoray products are not available for sale, distribution, technical support, software upgrades or repair in these countries: Cuba, Egypt, Indonesia, Iraq, Iran, Malaysia, Nigeria, North Korea, Kuwait and Saudi Arabia.

* - denotes required field

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