Optical Products Online Ordering

All foreign located companies and individuals (excluding US Government facilities) must call or e-mail (include telephone number where you can be reached).
All fields on this form marked * must be completed.
Confirmation of orders and notification of any items on backorder will be done via e-mail. Most orders will be shipped within 24 hours. The receipt of an e-mail confirmation does not constitute the acceptance of an order nor a confirmation of an offer to sell.
$50.00 minimum on all orders. All orders placed over $5,000.00 must obtain pre-approval with an acceptable method of payment, as established by our Credit Department.
Marshall Electronics and its affiliates are not responsible for any incidents that may occur as a result of using our online ordering system. Marshall Electronics will use the credit card information only for the intended purchase and the shipping costs.

Orders will appear on credit card statement as Marshall Electronics. Marshall Electronics will charge exact shipping and tax (where applicable). All shipments are made "best way" unless specified by the customer. COD is not available for online orders.

ORDERED BY:

First Name*:

Last Name*:

Company:

Line of business:

Address 1*:

Address 2:

City or Town*:

State or Province:

Zip or Postal Code*:

Country*:

Phone Number*:

Fax Number:

E-mail Address*:

Required for order confirmation

Shipping Method:

Shipping address (if different from above address):

First Name*:

Last Name*:

Company:

Address 1*:

Address 2:

City or Town*:

State or Province:

Zip or Postal Code*:

Country*:

Items you wish to order:

1.Part Number:

1.Quantity:

2.Part Number:

2.Quantity:

3.Part Number:

3.Quantity:

4.Part Number:

4.Quantity:

5.Part Number:

5.Quantity:

6.Part Number:

6.Quantity:

METHOD OF PAYMENT

METHOD OF PAYMENT:
Credit Card Number:
Expiration Date:
Name as it appears on the credit card:
*Cardholder Phone Number:**

Credit card billing address