VAPRECISION TESTING SYSTEMS FAX ORDER FORM
print this page in your web browser, fill it out, then fax it directly to us at 714-549-8245
Billing Information Shipping Information
_______________________________________________________ company name	_______________________________________________________ company name
_______________________________________________________ street address	_______________________________________________________ street address
_______________________________________________________ city/state/zip	_______________________________________________________ city/state/zip
______________________________________ _______________ contact name telephone	______________________________________ _______________ contact name telephone
_________________ ________________ Ground 3 Day Select 2nd Day Air Overnight __________________________ date of order time of faxing product(s) to be shipped via UPS (circle one purchase order number BILLING TO: (circle one) Visa Mastercard American Express Credit Card Number:_____________________________________ Exp. Date: ___________ Name on Card:____________________________

Calcium Chloride Test Kits & Accessories (all Packs Include pH Test Kits)
___	Contractor Pack	- 100 test kits in 1 box	$ 910.00	________
___	Commercial Pack	- 12 test kits in 1 box	$ 135.12	________
___	Survey Pack	- 3 test kits in 1 box	$ 35.55	________
___	Concrete pH Test Kit - Jumbo 100 pack		$ 8.00	________
___	Concrete pH Test Strips - 12 pack		$ 3.00	________
___	Concrete pH Pencil		$ 26.50	________
___	Reusable Safety Cones (12 safety cones per box)		$ 15.45	________
___	The Dome Press, Fast Kit Installer (Heavy duty wood frame)		$ 39.95	________
___	The Dome Press, Fast Kit Installer (Regular duty plastic frame)		$ 10.00	________
___	Tanita Portable Electronic Gram Weight Scale with Calibration Kit and Heavy Duty Field Case		$ 125.00	________
___	SawTec dustless grinder system		$ Please call for price
ELECTRONIC METERS
___	Tramex Concrete Moisture Encounter (Analog Scale)		$ 438.00	________
___	Tramex Moisture Encounter for Drywall Surfaces (Analog Scale)		$ 385.00	________
___	Wagner Concrete Proline - Concrete Moisture Meter Model C575 (Analog Scale)		$ 390.00	________
___	Wagner Inspector Proline - Wood Moisture Meter Model L606 (Analog Scale)		$ 310.00	________
___	Wagner Inspector Proline - Wood Moisture Meter Model MMC210 (Digital Scale)		$ 310.00	________
___	Wagner Inspector Proline - Extended Range Wood Moisture Meter Model MMC220 (Digital Scale)		$ 336.00	________
___	Wagner Inspector Proline Wood Meter Calibration Block (L606, MMC210, MMC220 only, no certs )		$ 45.00	________
___	Ballistic Carrying Case for Wagner Concrete Proline or Inspector Proline		$ 18.00	________
___	Vaisala HM-44 Insitu Probe Concrete Humidity Meter		$ Please call for price
ENVIRONMENTAL & OTHER MEASUREMENT INSTRUMENTS
___	Mannix Digital Temperature/Humidity Meter with Dew Point		$ 94.45	________
___	Mannix Digital K-type Thermometers		$ 89.95	________
___	Extech Hygro-thermometer Clock		$ 59.00	________
___	James Instruments ASR Detection Kit (10 test per pack)		$ Please call for price
___	James Instruments Carbonation Detection Kit (100 tests per pack)		$ Please call for price
___	Elcometer Coating Bond Strength Test		$ Please call for price

We will total your order, compute any sales tax and freight, and fax this page back to you as a receipt. If this information is not necessary, simply leave this part blank. Fax Receipt To: _________________________ Fax Number:__________________ Notes: rev 4/04			Sub Total	________
			Sales Tax	________
			Freight	________
			TOTAL	________