Please print names, catalog numbers, and prices as listed in the Reference Standards section of the USP Catalog. (For controlled
substances—CI, CII, CIII, CIV, CV, and List Chemicals—shipping to a foreign address, please add US$25.00 per unit and provide
appropriate paperwork. Call USP Customer Service at +1-301-881-0666 for a list of required documents.)
PrOduCT desCriPTiON CAT. NO. uNi T PriCe q Ty. TOTAl
_______________________________________________________ ___________ $ ________ ________ __________
_______________________________________________________ ___________ $ ________ ________ __________
_______________________________________________________ ___________ $ ________ ________ __________
_______________________________________________________ ___________ $ ________ ________ __________
_______________________________________________________ ___________ $ ________ ________ __________
_______________________________________________________ ___________ $ ________ ________ __________
_______________________________________________________ ___________ $ ________ ________ __________
Prices subject to change. usP reference standards are not returnable for exchange or refund. TOTAl
* quantity discounts: 5– 24 of same item ordered at one time=5% discount; 25 or more of same item
ordered at one time=10% discount. TOTAl less disCOuNTs*
** maryland residents add 6% sales tax. TAX** +
*** domestic orders are shipped via air courier (chosen by usP) at a charge of us$17 to a s Tree T
Address ONly (no P.O. boxes). Customers can choose their own carrier preference by giving usP dOmes TiC sHiPPiNG*** +
their dHl, uPs, or Fedex account number. All shipping charges are per order.
**** Foreign orders are shipped via air courier. Charges are per order and in u.s. dollars. FOreiGN sHiPPiNG**** +
Consult the zone freight map or chart located on the back of this form to find the base freight charge for the ship-to country of your order. misC. CHArGes +
Rush order charge: additional US$75 GrANd TOTAl
Promotion Code: GGq8VA
Your order cannot be processed if you do not provide ALL information
for the payment option you choose.
Ti Tle PAYMENT OPTIONS—CHOOSE ONE
1 Best payment option—ensures quick order processing with maximum security.
q CREDIT CARD m VISA m MasterCard m American Express
ziP COuNTry Credit Card # Exp. Date
Security Code (3-digit code on back of card)
emAil
Cardholder’s Name
Cardholder’s Signature
Phone ( )
2 Option available only for customers with prior credit approval or for U.S.,
Canadian, and selected European orders that total less than US$2,000.† Option
valid only if you send a copy of your purchase order or if you provide a purchase
order number with your order. For credit approval, call 1-800-227-8772, ext. 8171
(U.S. only), or +1-301-881-0666, ext. 8171; or email jvt@usp.org.
ziP COuNTry q BILL ME
Purchase Order #
FAX emAil
Signature
Phone ( )
3 If paying by check, mail this form and your check to USP.
q CHECK (Make checks payable to USP, in U.S. dollars drawn on a U.S. bank.
U.S. checks must be microcoded.)
Phone ( )
4 Call 1-800-227-8772, ext. 8177 (U.S. only), +1-301-881-0666, ext. 8177; or email
em@usp.org for payment instructions.
CAT011G
q WIRE (Electronic Funds Transfer)
† See p. 129 for a list of applicable European countries. For orders in other countries,
please contact your account manager or custsvc@usp.org.
BILL TO
NAme
OrGANizATiON
Address
CiTy sTATe
TelePHONe FAX
SHIP TO
ORDERS CANNOT BE PROCESSED WITHOUT A NAME
TiTle
NAme
OrGANizATiON
Address ( We CANNOT deliVer TO A P.O. BOX)
CiTy sTATe
TelePHONe
I expect to be ordering Reference Standards on a regular basis.
Please send me the bimonthly USP Catalog.
Please send me monthly email notices.
HOW TO ORDER
USP Reference Standard listings on
www.usp.org
1-800-227-8772 (U.S. and Canada),
+1-301-881-0666,
00-800-4875-5555 (Europe)
Fax order form to +1-301-816-8148
Mail order form with payment to
USP
Customer Service Department
12601 Twinbrook Parkway
Rockville, MD 20852
USA
