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  Order Form :::::

Please complete the Order Form if you're interested in our products. We will quote promptly after reviewing the structure of the product within 24 hours.

Please complete all the required fields of this form to receive a prompt quotation on your peptide.

General Infomation
First Name: Last Name: Mr. Ms.
Company/Institute:
Address: Zip Code:
City: State/Province: Country:
Telephone: Fax: e-mail:
Products Infomation
Product Name:  Product Number:
Quantity:  Weight: 100mg 50mg                  Quote: $
Comments:
Payment Methods
By Credit Cards
Master Card
Visa Card
American Express Card
JCB Card
 
Credit Card Number: Expiration Date: - (MM-YY)
Name of the Card Holder: Birthday: (DD-MM-YYYY)

By Bank Telegraphic Transfer
THE DETAIL OF REMITTANCE
1.BENEFICIARY'S BANK:
BANK OF CHINA, LIAONING BRANCH DALIAN HI-TECH SUB-BRANCH, DALIAN, CHINA
TLX: 86163 CDB CN
SWIFT: BKCHCNBJ810
2. BANK'S ADDRESS:
NO.2 GAOXIN STREET QIXIANLING INDUSTRIAL BASE OF DALIAN HI-TECH
INDUSTRIAL ZONE DALIAN CHINA
3. BENEFICIARY'S A/C NO: 4191015824108091014
4. BENEFICIARY'S NAME AND ADDRESS:
Name: Dalian Bio Integration Technology, Inc.
Address: No. 26 Gaoneng Street, Room 404, Dalian High-tech Zone, Dalian, LN 116025, China
      
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