Order Form for The Interactive FDG Whole Body Atlas CD-ROM (Macintosh or PC)

Price list

1-50 CDs= $200

51-200 CDs= $100

201-500 CDs= $35

500 & up= $15

Shipping Information

First Name:_______________ Last Name: _______________________ Degree:__________

Company: ______________________________________________________________________

Department: ___________________________________________________________________

Division: _____________________________________________________________________

Address: ______________________________________________________________________

City: ___________________________ State: ____________ Zip: ____________________

Country: ______________________________________________________________________

Phone: ______________________ Extension: ___________ FAX: _____________________

                                                          Quantity: ___________
                                                             
                                                        Cost (ea):  US $ 200.00

                                                         Sales Tax: ___________
                                                     (CA add 8.25%)

                                                          Shipping: ___________
                                   ($3 domestic; $32 international)

                                                             TOTAL: ___________

State Sales Tax
California purchasers must add 8.25% state sales tax
Shipping
Domestic shipping is via two-day priority mail. International shipping is by UPS International Air Service.
Method of Payment
All payments must be made with US funds. Payment must accompany your order form to initiate shipment.

Please make check or money order payable to:

The Regents of the University of California

Send payment and order form to:

Crump Institute for Biological Imaging
UCLA School of Medicine
700 Westwood Plaza A-236 JLNRC
Los Angeles, CA 90095-1770
ATTN: Theresa Sama

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