* RICE MICROARRAY ORDER FORM
When ordering microarrays, please download and complete this Biological Material Agreement, and mail the signed original to:
Irma Alvarado-Sipp, Procurement and Contracting Services, University of Arizona, P.O. Box 210300, Tucson Arizona 85721 USA.

Please also FAX or mail a copy of the signed BMA to:
Department of Plant Sciences, Attention: David Galbraith, 303 Forbes Building, Tucson Arizona, 85721 USA (FAX: +(520) 621-7186).

Questions concerning the BMA should be directed to Irma Alvarado-Sipp.

Fields marked with an asterisk * are required.
* Numbers of arrays requested

* First Name * Last Name
* Email Address  * Telephone Number  * Fax Number
Shipping Address
* Street Address 
* City  * State  * Zip/Post Code 
* Country 
Billing Address (if different from shipping address)
To the Attention of 
Street Address 
City  State  Zip/Post Code 
Country 
* University, Government or Not-for-Profit Affiliation 

For shipping purposes, you MUST provide a FedEx number, otherwise we will not be able to process your order. If you wish to use a shipping service other than FedEx, please specify the service in the comment box below.

FedEx Number

Payments for the microarrays can be made in a number of different ways
(1) by money order or check
(2) by credit card
(3) by wire transfer
(4) by ACH transfer

Please indicate your preferred method of payment in the following box
Payment method

Comments

If you have questions about completing this form or need assistance, contact arrayorders@ag.arizona.edu.