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Purchase Order  # 
 Company:
 
 Address:
 
 City, State, Zip:
 
To submit this form, please complete all  editable fields ,  print  this form and FAX it to us at 281.870.1279. Alternatively, you can  print  this form out and complete it by hand.
 To:
 MetaLab Inc.
 Ship to:
 
 Attention:
 
 Address:
 14355 Schiller Road
 Address:
 
 City, State, Zip:
 Houston, TX, 77082
 City, State, Zip:
 
 Phone:
 281-870-1014
 Phone:
 
Date
Date required
Terms
How shipped
Req. number or Dept.
      For      
Item descriptionPriceQuantityTotal
PractiCAM software set (including the annual maintenance program for the first year)$19,950.00
PractiCAD software set (including the annual maintenance program for the first year)$11,995.00
Discount (code: )  
Total  
Important
Purchase order number must appear on all invoices, packaging, etc.

Please notify us immediately if you are unable to complete the order by the specified date.

Please send copies of your invoice with the original bill of lading.

 Authorized purchasing agent:

Terms and Conditions
 Submited by:
 
 Tax ID (or SSN):
 
 Address:
 
 City, State, Zip:
 


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