Printable Form

Print This Order Form and Fax or Mail To:

Nuclear Technology Services, Inc., 635 Hembree Parkway, Roswell, GA 30076

Fax: 1-770-663-0547 or phone 1-770-663-0711. (hermonrao2@aol.com)

List shipping address and billing address below. For credit card purchases, billing address must match billing address of credit card. Please provide all information requested.

Billing Address **********************************Shipping Address

__________________________________________|___________________________

__________________________________________|___________________________

__________________________________________|___________________________

Email address__________________________________________________________

Phone number_______________________________Fax________________________

Name of Item-------------------------Quantity---------Unit Cost----------------Total Cost

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

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************************************************* Shipping cost_____________

************************************************* Grand total_ _____________


Payment Method (circle one)----Check----Purchase order----Credit card

Type of card (circle one)-- Mastercard-----Visa----American Express- --JCB

Card number________________________________________________________

Name on card_____________________________________ Expiration date____________

Signature of card holder approving purchase_____________________________________
(Overseas customers send fax copy of card)

Note: We will send you an email message to confirm receipt of your order. If shipping is by Federal Express or UPS, we will provide a tracking number for you to track your shipment. If possible, please list shipping cost on this order form. Our shipping charges for shipments within the United States are given on our main web page. For shipments outside of the United States, we can send you a quote of shipping charges, by email.