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CMS-II: SQL Data Acquisition & Central Monitoring System

Model TS4: Multiple Probe Temperature Monitor Alarm

Model 140: Single Probe Temperature Monitor Alarm

CA 5000: Freezer Temperature Monitor, Alarm, with CO2 Backup System

Hampshire Controls Corporation

STANDARD ONLINE ORDER FORM

NOTE 1: FOR ALL "SECURE" CREDIT CARD ORDERS, PLEASE CLICK HERE. [NOTE: SECURE ORDERING WILL NOT BE AVAILABLE DURING SERVER UPGRADE AND MAINTEANCE - FROM THURSDAY, JUNE 10 THROUGH MONDAY JUNE 14].

NOTE 2: To MAIL or FAX an orders - Click Here for a PDF Order Form.

*INDICATES REQUIRED INPUT FIELD

1). *Full name:
2). *Company name:
3). *Phone number: (include area code and extension):
4). *Fax number: (include area code):
5). *E-mail address:
6). *Zip/Country Code:
7). *List product name, item number, and quantity and price for each:
8). *SHIP TO ADDRESS:
9). Fright collect billing account number (if applicable):
10). Purchase Order number:
11). *BILL TO ADDRESS:

12). *How do you wish your product shipped?	Ground Second-day Third-day Overnight Cheapest way
13). *Have you used a Hampshire Controls product before?	Yes No
14). If "yes" to the above question, which product(s) have you used?
15). Please list the application(s) used for our product(s).
16). *How did you find out about Hampshire Controls Corporation?	I'm presently a customer Co-worker Professionals' recommendation Internet search
17). Add any additional comments or questions below:

Hampshire Controls Corporation
1 Grove Street, PO Box 516, Dover, NH 03821-0516
(Call Toll Free in the US) 866-496-9424 - (Worldwide) 603-749-9424
(Fax) 603-749-9433
(Email) sales@hampshirecontrols.com