Order Form

The RIAC offers an extensive line of reliability, maintainability, quality, supportability, and interoperability related products.

Complete and print this form and FAX to (315) 351-.4209 or mail to:
Reliability Information Analysis Center
6000 Flanagan Road
Suite 3
Utica, NY 13502-1348

Credit cards (MasterCard, VISA, and AMEX) are accepted for purchases of $25 and up. All Non-US orders not paid by credit card must be accompanied by a check for US funds drawn on a US bank.

1. Billing Address: Please include phone and fax information.
      Name ___________________________________________________
      Address _________________________________________________
      City ______________________ State/Province __________ Zip/Postal Code ___________
      Country (if not USA)____________________________
      Phone (____)__________________ Fax (____)__________________
      E-mail Address ___________________________________________

2. Shipping Address: Fill in only if different than ordering address.
      Name ___________________________________________________
      Address _________________________________________________
      City ______________________ State/Province __________ Zip/Postal Code ___________
      Country (if not USA)____________________________

3. Orders: Please Print Clearly.

	Product Code	Qty.	Name	Delivery Method	Item Price	Total Price
1
2
3
4
5
6
Subtotal
Click here for S&H options. Shipping and Handling
Total Amount Enclosed

4. Payment Method:

Check (payable to Wyle Laboratories/RIAC)
Purchase Order (Attach PO to Wyle Laboratories/RIAC)
Mastercard
VISA
American Express

      Account Number: ______________________________________
      Card Expiration Date: _____/_____
      Customer Signature: _______________________________________