EmailMe Form - Manual Order Submission (V6)

Name *

First Last

Phone Number *

### - ### - ####

Email *

Company

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Items Ordered *

You can copy/paste your cart directly from the website, or hand-write a list. For your convenience, adding prices isn't necessary. Please add one item per line, separating each with an enter.

Select Shipping Option *

Prices vary considerably due to client location & items ordered. An accurate shipping quote will be provided after manual order submission. The pick up option is for our location in Plainville, CT.

How would you like to be billed?

Get a call from NEHERP for debit/credit payment (+$0.00)

Email payable invoice (+$15 document generation fee)

Email tax exempt invoice (+$15 document generation fee)

NEHERP Gift Certificate | Include number below | (+$0.00)

IMPORTANT NOTES:
1) Do not include credit card or debit card information on this form.

2) Tax exempt invoices available to approved institutions only, after our tax exempt forms have been accurately filled out & approved. See link for details: https://www.neherpetoculture.com/taxexempt

3) If you are redeeming a NEHERP Gift Certificate, be sure to type the certificate number into the box provided. (Appears after you check the box)

Comments and Questions

Anything you'd like us to know about your order?