Purified Toxin Standard Order Form Phone Shipping Details Name * Company Phone * Email * Address * Address Line 2 City State State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code Shipping details the same as billing details? Yes. The details are the same. No. I need to provide different details for billing. Microcystins Number of vials for Microcystins MC-RR 25 µg at $100 per vial Number of vials for Microcystins MC-RR 100 µg at $200 per vial Number of vials for Microcystins MC-RR 500 µg at $800 per vial Price for MC-RR 25 µg $ Price for MC-RR 100 µg $ Price for MC-RR 500 µg $ Number of vials for Microcystins [D-Leu1] MC-LR 100 µg at $425 per vial Price for [D-Leu1] MC-LR $ Number of vials for Microcystins MC-LA 25 µg at $125 per vial Number of vials for Microcystins MC-LA 100 µg at $250 per vial Price for MC-LA 25 µg $ Price for MC-LA 100 µg $ Cylindrospermopsin Number of vials for Cylindrospermopsin CYN 25 µg at $100 per vial Number of vials for Cylindrospermopsin CYN 100 µg at $200 per vial Number of vials for Cylindrospermopsin CYN 500 µg at $600 per vial Price for CYN 25 µg $ Price for CYN 100 µg $ Price for CYN 500 µg $ SubTotal SubTotal $ Additional Shipping costs will be determined on day shipped
