Bill To:
 
Name:    ________________________________________________  P.O.#: _______________
 
Company: ________________________________________________________________________
 
Address: ________________________________________________________________________
 
City:    ________________________________________________________________________
 
Province/State:_________________________________________  Zip: __________________
 
Phone:   ________________________________  Fax: _________________________________
 
Email:   ________________________________________________________________________
 
Credit Card #  __________________________________   Exp. Date:   ________________

Credit Card Billing Address   ___________________________________________________
 
Security Code (back of card) ______   Name on Card:   ___________________________
 
Thin Sections
 
Size of Section:  ____________________________       Cover Slip:   Yes      No
 
Impregnation:  Blue    Clear    Fluorescent :Yellow  Pink         No Impregnation
 
Polishing:     Micro Probe Polish     No Polish
 
Staining:      Calcite (ARS)    Iron Rich Carbonate (ARS & Potassium Ferricyanide)
               Potassium Feldspar         Plagioclase           No Staining
 
Ground in Oil: Yes   No       Orientation: Yes   No
 
 
Turnaround Time
Normal Turn around (Call for current schedule)
Drilling Well (24 hours)  Super Rush (2-5 Days)   Rush (10 Days)
 
 
Engraving Information:
 
1.  ________________________  11. _______________________  21. ____________________
 
2.  ________________________  12. _______________________  22. ____________________
 
3.  ________________________  13. _______________________  23. ____________________
 
4.  ________________________  14. _______________________  24. ____________________
 
5.  ________________________  15. _______________________  25. ____________________
 
6.  ________________________  16. _______________________  26. ____________________
 
7.  ________________________  17. _______________________  27. ____________________
 
8.  ________________________  18. _______________________  28. ____________________
 
9.  ________________________  19. _______________________  29. ____________________
 
10. ________________________  20. _______________________  30. ____________________

Billing: National Petrographic Service accepts Visa, Mastercard, American Express or Check. If a P.O. # is necessary for processing payment with your organization, please include the P.O. # when available. Otherwise, an invoice will follow the shipped work within 5 working days and will be addressed to the "Bill To" recipient.