Order Form to DKN Research
To place an order by Fax or Mail print this form, fill out the required information below and fax, email, or mail the completed form.
Fax: 1-978-469-0188
Email: sales@dknresearch.com

Mail Envelope to:
DKN Research
62 Adams Street
Haverhill, Massachusetts 01830
1. Product Order Information:
Item Name Price
A. Fine Line Thick Film Conductors Trial Kits: ASP-Trial-FL80 US$ 890.00
B. Printed Resistors and Capacitors: ASP-PCRC1000 US$  49.00
C. US$
D. US$
E. US$
F. US$
G. US$
H. US$
Total US$
2. Delivery Information:
Copy choice: CheckBox1-1 E-Mail CheckBox2-2 Hard copy by surface mail (Choose between E-mail or Hard copy)
Name:  
Division:  
Company:  
Address:  
Phone Number:  
e-mail address:  
3. Payment Information: (Please indicate your preferred method of payment.)
By Check

Check enclosed
Amount: US$

US$
By Credit Card
Card Type: CheckBox2-1 VISA card, CheckBox2-2 Master card (Choose between VISA or Master)
Cardholder name:  
Card number:  
Expire date:   Card security Code:
 last 3-bigit code(CVV2,CVC2) in the sigunature area on the back of the card 		 
Billing address:  
4. Signature:
Signature

Name:

Date: