ORDER FORM

Please contact us by telephone, mail or fax to place or inquire about orders. Thank you. 

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Scientific Enterprises, Inc. ______ Payment Enclosed
Department WP
5104 Randolph Road 
North Little Rock, AR 72116 ______ Purchase Order #______________ 
(501) 771-1775                         

FAX (501)  771-1775

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Name _______________________________ Position ___________________________

Hospital/Affiliation ________________________________________________________ 

Mailing Address _________________________________________________________

City ___________________________________________________________________

State ______________ Zip ____________________ 

QUANTITY	DESCRIPTION	UNIT COST	TOTAL COST
Airmail Overseas Charges
Total Cost in US Dollars

ALL FOREIGN ORDERS MUST BE PREPAID IN U.S. DOLLARS

Clinical & Biomedical Engineering	Hospital Safety
Hospital Engineering	Self-Study Courses
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