Secure online order form

Order Information
Item #	Model #	Quantity
1
2
3
4
5
6
7
	Additional Comments

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
Credit Card Number* We do not accept American Express
Credit Card CVV Number* Printed on the back of your card, by the signature panel
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.

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

SENSORAY | 7313 SW Tech Center Dr. | Tigard, OR 97223 | 503.684.8005 | Email Us

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