ORDER FORM

Phone: 704-670-0042 / Fax: 866-404-2996

Toll Free: 877-629-7197

8:00am -7:00pm EST.

Discount Laboratory Equipment and Supplies

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Leigh Labs Order Form

Please fill in the form and submit your order. Leigh Labs will verify and process your order immediately.

Bill To Name		Phone
Institution		Purchase Order Number
Bldg / Rm		Quote Number (if applicable)
Street		Credit Card Number
City		Exp. date
State		Ground 3 Day Select 2nd DayOvernight
Zip		Special Instructions
Ship To:
Item#	Quantity		Price

Leigh Laboratories, P.O. Box 1306,Waxhaw, NC, 28173 Ph: (704) 670-0042, Fax: (866)-404-2996. sales@leighlabs.com