http://www.industrologic.com             info2008@industrologic.com

January 1st, 2008: Please note that the prices of some of our products have increased.
Refer to the Products page or the product brochure pages for updated pricing.
Order Form                      Product        Quantity   Price   Item Total

Industrologic, Inc.             ____________   ________   _____   __________
3201 Highgate Lane
St. Charles, MO                 ____________   ________   _____   __________
63301  USA
                                ____________   ________   _____   __________
Phone: (800) 435-1975
       (636) 723-4000           ____________   ________   _____   __________
FAX:   (636) 724-2288
Sales/Support: 9AM to 5PM Central
Email: info2008@industrologic.com                 Product Total   __________

If shipping to a Missouri address add 5.90% for Sales Tax         __________

Normal shipping is UPS with charges added, or     1 Day Air __  2 Day Air __
we can use your FedEx or UPS account number.      3 Day Select __  Ground __

FedEx account _____________________________ UPS account ____________________

Shipments outside the US require your billable FedEx or UPS account number.
Shipping charges, tariffs, and any value added taxes (VAT) will be billed
to this account number.

Name: ________________________________________________ Date: ___ / ___ / ___

Company: ___________________________________________________________________

Address: ___________________________________________________________________

City: _________________________________ State: __________ Zip: _____________

Phone: ( ______ ) ______ - ________     Email: _____________________________


Credit Card: __ VISA  __ MasterCard   Expiration Date (MM/YY): __ __ / __ __

Name as it appears on card: ________________________________________________

Billing address of card: ___________________________________________________

Credit Card Number: __ __ __ __ - __ __ __ __ - __ __ __ __ - __ __ __ __

3 Digit Verification Number (from back of credit card): __ __ __

Purchase Order Number: _______________  Issued by: _________________________

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