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Complete, and fax or mail to:
Rugate Technologies, Inc.
353 Christian Street
Oxford, CT 06478

Fax: 203-267-3157

Questions? e-mail: info@rugate.com

Note: When printed, this order form may be multiple pages. Please make sure that all pages are printed and completed so we can fill your order completely and accurately. Thank you.

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Date: __ __ - __ __ - 20 __ __

Rugate Technologies, Inc. 2006.

Metrology Order Form

Name:

  

Company:

  

Phone:

  

Fax:

  

Address:

  

Description of Part:

  

Description of Measurements:

  

Transmission:

min: ______________________ | max: ______________________

Reflection:

  

Do you want data on CD?

Do you want data e-mailed?

e-mail address: _______________________________________

END OF ORDER FORM.
Thank you for your order.