General Electric Company            Phone:  1-954-481-1800

1111 W. Newport Center Dr.         Fax:      1-954-481-1804

Deerfield Beach, FL 33442

www.gemicron.com

Product Order Form

Fields in Red are Optional. All other fields MUST be filled in, or your order cannot be processed.

Account Information: Click Here for Help.
Account Number:
Customer Name:
Requester's Name:
E-mail Address:
Telephone Number:
Fax Number:
Purchase Order Number:
*If you do not have a PO, please indicate VERBAL to pay by other arrangements.
Bill To Address: Click Here for Help.
If you do not need to update your Billing Address, you can skip this section.
Name:
Address1:
Address2:
City:
State:
Zip:
Country:
Ship To Address: Click Here for Help.
This section is required, however, if this is the same as your normal Bill To Address, please indicate "SAME" in each field.
Name:
Address1:
Address2:
City:
State:
Zip:
Country:
Method of Shipment:	UPS Ground UPS Blue UPS Red UPS 3rd Day UPS Red Saturday Delivery UPS Third Party UPS International UPS Collect UPS Consignment Red UPS Consignment Blue UPS Consignment Orange UPS COD Red UPS COD Blue UPS COD Ground FedEx International Express Mail Air Parcel Post Burlington Air DHL Worldwide Priority Mail Express Mail A/O Air Mail Registered Air Mail Pickup/Deliver Stamps
If none is selected, the order will be shipped via UPS Ground. Click Here for Help.
Material to be Shipped: Click Here for Help.
Product Description Container Type & Size Quantity Unit Expected Delivery (mm/dd/yy) Expected Unit Price(US$) Total 1 carats grams other 2 carats grams other 3 carats grams other 4 carats grams other 5 carats grams other 6 carats grams other 7 carats grams other 8 carats grams other 9 carats grams other 10 carats grams other             Total:
Comments or Other Instructions: Click Here for Help.

Fields in Red are Optional. All other fields MUST be filled in, or your order cannot be processed.

Need to request an RMA? Click Here.