LANDING BIOTECH INC ORDER FORM fax: 617-964-1187 email: sales@landingbiotech.com Name of Customer________________________________Req. by______________ Date____________Acc. #__________________________P.O. #_______________ Date Order Placed______________ Catalog No. Quantity Item Unit Price Total Cost ====================================================================== __________ ______ _________________________ __________ _________ __________ ______ _________________________ __________ _________ __________ ______ _________________________ __________ _________ __________ ______ _________________________ __________ _________ __________ ______ _________________________ __________ _________ __________ ______ _________________________ __________ _________ __________ ______ _________________________ __________ _________ __________ ______ _________________________ __________ _________ __________ ______ _________________________ __________ _________ __________ ______ _________________________ __________ _________ __________ ______ _________________________ __________ _________ __________ ______ _________________________ __________ _________ __________ ______ _________________________ __________ _________ __________ ______ _________________________ __________ _________ __________ ______ _________________________ __________ _________ ====================================================================== Notes:________________________________________________________________