JRF Domestic (within US) Purchase Order Form
If you are ordering replacement heads, MRL Test Tapes, parts etc, use this form
Thank you for choosing JRF Magnetic Sciences Inc.  In order to process your request as quickly as possible and keep questions to a minimum, please complete this order form, save it as a screen shot or PDF, and email it to jrf@jrfmagnetics.com. Questions? Contact us at:

JRF Magnetic Sciences Inc. 
Phone: 973-579-5773  email:  jrf@jrfmagnetics.com
Your Name:
Your Company:
Telephone:
E-mail:
Following are the items that we would like to purchase from JRF Magnetics:
Quantity
Description / Part Number
Price (if known)

Shipping Instructions:
US POSTAL SERVICE (USPS): . Slow Mail..... Priority Mail...... Priority Express (1 day)
UPS: .... Ground . 3 Day . 2nd Day... ..Next Day.
Other (specify): Account No.

Insurance amt: I do not want my package insured – Initial herel:

Payment: 
JRF accepts Visa, Mastercard, and American Express cards, plus Paypal. If you wish to email your card data, please divide the data into 3 separate emails (separately from this form) for security - or call your information in to us at 973-579-5773. Your order will be filled once we have your payment.

Credit Card Number: Expiration:
Name on Card: Security Code (CVV):

JRF Paypal account number:     jrf@jrfmagnetics.com