C.L.O.N.E Buffer Order Form
Please use this form below to order our CLONE Freezing, Chilled, and Activator Buffers. Once your order is placed please allow 2-3 for processing. We do not ship out on Fridays.
Contact Name
*
First Name
Last Name
Hospital Name
*
Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Need By Date
*
-
Month
-
Day
Year
Date
Any special delivery instructions?
*
Buffers Options
*
Chilled Buffer- Orange ($27.00)
Frozen Buffer Set - Yellow & Green ($40.00)
Thaw Media - $20.00
Please indicate how many of each Buffer you would like to order:
*
Below indicate where you would like your Invoice sent:
We send our invoices through Quickbooks. We appreciate payment prior to shipping out your package. FedEx Shipping & Dry Ice are not included in the Buffer fee above.
Email
*
example@example.com
Signature
*
Preview PDF
Submit
Should be Empty: