Purified Toxin Standard Order Form Company Client Information Client Name Client Address Client Company Client Phone Client Email Billing Information Billing Name Billing Address Billing Company Billing Phone Billing Email Microcystins Number of vials for Microcystins MC-LR 100 µg at $150 per vial Price for MC-LR $ Number of vials for Microcystins [D-Leu1] MC-LR 100 µg at $425 per vial Price for [D-Leu1] MC-LR $ Number of vials for Microcystins MC-RR 100 µg at $200 per vial Price for MC-RR $ Number of vials for Microcystins MC-LA 100 µg at $250 per vial Price for MC-LA 100 µg $ Number of vials for Microcystins MC-LA 25 µg at $125 per vial Price for MC-LA 25 µg $ Cylindrospermopsin Number of vials for Cylindrospermopsin CYN 500 µg at $600 per vial Price for CYN 500 µg $ Number of vials for Cylindrospermopsin CYN 100 µg at $200 per vial Price for CYN 100 µg $ Number of vials for Cylindrospermopsin CYN 25 µg at $200 per vial Price for CYN 25 µg $ SubTotal SubTotal $ Additional Shipping costs will be determined on day shipped
