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Fax to: The Marketing Research Bureau Inc.
Fax: +1 203 891-8855
ORDER FORM INTERNATIONAL DIRECTORY OF PLASMA PRICE & DELIVERY $695.00 (Six hundred ninety five U.S. dollars) Until April 30, 2008, $795 Thereafter. Shipment will be made by priority mail within the U.S. upon receipt of the order or payment, and by airmail for international orders. |
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Please send the Directory by overnight courier (add $25.00 for domestic |
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shipment $75.00 for international) | |
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Please send the report electronically in a pdf format (add $55.00) |
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Email address:_______________________________________ |
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Please send the tables and charts in an excel format (add $100.00) by email. |
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PAYMENT : | |
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PAYMENT FOLLOWS BY CHECK in US dollars, issued on a U.S. Bank or U.S. correspondent bank or by WIRE TRANSFER to Bank of America, Orange, Connecticut 06477,USA, Account number 003850938248, routing number 0260-0959-3. Swift code: BOFAUS3N |
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BY ENCLOSED CHECK in US dollars, issued on a U.S. Bank or U.S. correspondent bank |
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PLEASE BILL ME Purchase order Number (optional)________________________________ |
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BY CREDIT CARD |
Visa / Mastercard / Eurocard |
American Express |
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Card Number ____________________________________________________________ |
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Expiration date __________________________________________________________ |
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Signature________________________________________________________________ |
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Please print your name___________________________________________________ |
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REPORT TO BE SENT TO: Name ____________________________________________ Title _____________________________________________ Company _________________________________________ Address __________________________________________ City/Postal Code___________________________________ Country ___________________________________________ Telephone _______________ Fax: ____________________
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