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Order Form

To order directly from MRC Holland, please complete the form below. If you have questions about orders, quotes, prices, or shipments, or need help with this form, please contact us. Our price list with list prices can be found here. We recommend requesting a personalised quote to ensure pricing reflects your specific situation.

Contact details

Full name

Email address

Phone number

Company/institute name

Customer number (7-digits)

Purchase order number

Billing address

Shipping address

The address goods will be delivered to.

Invoice email

The email address your invoice will be sent to.

VAT number (European Union only)

Product details

Comments

Optionally specify one or more email addresses in the CC field that will receive a copy of this order form.

Items, Descriptions, Quantities

List the items and quantities that you want to order. Please use product codes (e.g. P002-100R, EK1-FAM) together with the product names (e.g. BRCA1) as much as possible to minimize the chance of confusion.
(e.g. P040-025R SALSA MLPA P040 CLL probemix – 25 rxn 1)

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Order Form

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