GeoCHEM, Inc. Secure Online Order Form

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THIS SECURE ONLINE ORDER FORM IS FOR THOSE PRODUCTS QUOTED DIRECT TO THE CUSTOMER BY GEOCHEM, INC. WHICH ARE NOT AVAIALBLE TO PURCHASE VIA OUR ONLINE STORE. IF YOU HAVE RECEIVED A QUOTATION FROM GEOCHEM, INC. YOU CAN UTILIZE THIS SECURE ONLINE ORDER FORM TO SUBMIT YOUR ORDER.

Information submitted here is processed through a secure server. Our Secure Online Order form offers you, our customers, the convenience of ordering with your credit card. Our secure server makes it extremely difficult and unlikely for anyone to intercept and read information between your computer (our customer) and the server (GeoCHEM, Inc.) to which you are making a connection.

A Printable Order Form is also available for you to fax or mail your order into GeoCHEM's Sales Department if you prefer. We hope this helps the many who have requested some sort of secure way to order online and trust it will generally be more convenient for you, our customers. Click Here For Our Printable Order Form To Order By Fax or U.S. mail

Phone: 1.800.490.5320 or Contact Us online.

This form will submit the data entered into the fields below, at which time you will receive an expedient response. By submitting this form you agree to our Trademark, Copyright, Disclaimer & Opt-In Email. To ensure delivery of our response to your inbox (not bulk or junk folders), please add geocheminc.com to your safe list.

"Total Peace of Mind" Privacy Policy

We respect your email privacy. We will never give, trade, sell or rent your email address to any unauthorized third party online or offline PERIOD!

Deliver Order To

Full Name: *

Company name:

Address 1: *

Address 2:

City: *

State/province: *

Zip / Postal Code: *

Country:

E-mail: *

Phone Number:

Billing Address

Full Name: *

Company name:

Address 1: *

Address 2:

City: *

State/province: *

Zip / Postal Code: *

Country:

E-mail: *

Phone Number:

Line	Price	Quantity
1*
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(A) Total amounts in lines 1-10		Sub-total:
(B) Add Freight Charges		Total Freight Charges:*
(C) Sales Tax (If applicable)		Total Applicable Tax:
Total rows "A" thru "B" thru "C"	Total:

Credit Card Type: * Visa Mastercard Discover

Credit Card Number *

CVV Number *

Exp. Date *

Name on Card *

* Shipping cost varies by weight, method and distance shipped. We will contact you via e-mail or phone to verify your order and inform you of the shipping cost before processing your order if not already confirmed prior to you filling in the order form above. Thank you.

If you have any questions, you may reach us by phone at 1-800-490-5320 during business hours or contact us online. Clicking the "Submit Form" button will send the contents of this form, via secure server to the Order Department of GeoCHEM, Incorporated.

$600.00 Minimum Order On All Geo Ice Rink Liners Plus (+) Freight.

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GeoCHEM, Inc. Secure Online Order Form

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