GEMS Order Form

Mailing Address:

University of California, Berkeley
GEMS
Lawrence Hall of Science #5200
Berkeley, CA 94720-5200

To order by phone or fax:

Phone (510) 642-7771

Fax (510) 643-0309

Name ______________________________________

Address_____________________________________

___________________________________________

City________________________________________

State__________________Zip___________________

Phone ______________________________________

Billing Address (If different from shipping)

___________________________________________

___________________________________________

___________________________________________

___________________________________________

___________________________________________


Item Name Quantity Unit Cost Total Cost
       
       
       
       
       
       
       
       
       

Shipping Charges and Taxes:

Please calculate shipping charges and taxes
based on the
guidelines posted at www.lhsgems.org/orderinfo.html

Payment Information

Check#__________________

PO #______________________

Organization FEIN# (required for use of a PO):

_____________________________________

Credit Card Information:

Number:__________________________________
(MC, Visa, Discover — circle one)


Expiration Date:__________________


Signature:________________________________

Subtotal_____________________

CA Tax_____________________

Shipping____________________

Total_______________________


Please make checks to:
Regents of the University of California
.

Lawrence Hall of Science    © 2017 UC Regents. All rights reserved.    Contact GEMS    Updated February 06, 2015