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Invoice address/ customer registration

Please enter your full address here.
Unless you fill in an alternative location in the corresponding fields below, we will also use it as delivery address. Please keep in mind that courier services cannot deliver to PO boxes.

Note: fields marked with an asterisk ( * ) are mandatory.

Title: *
First Name: *
Last Name: *
Institution: *
Dept./Address: *
ZIP: *
City: *
Country: *
State: *	State / Province (USA / Canada)
Email: *
Re-type Email: *	Confirmation mails will be sent to this email address.
Password: *
Re-type Password: *
Fax:
Telephone: *
VAT no. (EU customers):

Alternative delivery address

If you wish your goods to be delivered to a location different to the invoice address above, please fill in the following fields.
You can also enter the contact person/email at this location.

Contact Person:
Institution:
Dept./Address:
ZIP:
City:
Country:
State:	State / Province (USA / Canada)
Telephone:

Notice

If you have questions regarding your order or want to make a comment, please use the corresponding field below. You can also enter your shipping account number here which might facilitate shipping of your purchase order (US$ 7.00 handling fee for US customers).

Notes:

Mailing list

I would like to receive product updates by e-mail.

Please add my name to your mailing list.

Conditions of Sale

Herewith I confirm to have read the conditions of sale:

I agree with the Conditions of Sale*

Note: fields marked with an asterisk ( * ) are mandatory.

Registration and creating a web account is necessary for placing an online order in Biolog's e-shop. As an already registered user you can enter your username and password above to login. If you are not yet registered with us please create an account by entering your contact information on the left side.

We will handle all your submitted information confidentially and will not share it with any third party except in the case of authorized distributors of Biolog Life Science Institute for selected countries.

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