Aerogel Order Form

Marketech International Inc.
107 Louisa Street
Port Townsend, WA 98368
Tel: 360-379-6707

Toll Free: 877-452-4910
Fax: 360-379-6907
info@mkt-intl.com

Aerogel Order Form

Either use the form below or print out this PDF version and fax it to 360-379-6907.

Enter the number of units you'd like to order in the quantity field(s) below, then enter your name, address and payment information. Click Submit to send us your order.

First Name*

Last Name*

Company

Address*

City*

State/Province*

Zip/Postal Code*

Country*

Billing Address is the same as Shipping Address

Billing First Name

Billing Last Name

Billing Company

Billing Address

Billing City

Billing State/Province

Billing Zip/Postal Code

Country*

Phone*

Email*

Payment

M/C VISA American Express

Discover COD ($9.00 per box)

Credit Card Number

Expiration Date

Special Instructions

Silica Aerogels: Random 0.2 to 2.0 cm pieces
10 grams	$148.50	Quantity:
50 grams	$550.00	Quantity:
100 grams	$880.00	Quantity:
Silica Aerogels: Monolithic Block
2x2x0.5"	$252.00	Quantity:
4x8x0.5"	$1228.50	Quantity:
RF Aerogels: Random 1 - 2 cm pieces
20 grams	$99.00	Quantity:
100 grams	$248.00	Quantity:
500 grams	$570.00	Quantity:
RF Paper: 3.5" x 10" x 0.01"
10 sheets	$165.00	Quantity:
50 sheets	$462.00	Quantity:
100 sheets	$880.00	Quantity:
Carbon Aerogels: Random 0.2 to 2.0 cm pieces
20 grams	$127.00	Quantity:
100 grams	$363.00	Quantity:
500 grams	$1055.00	Quantity:
Carbon Paper: 3.5" x 10" Paper Grades
Type 1
5 sheets	$132.00	Quantity:
10 sheets	$198.00	Quantity:
50 sheets	$627.00	Quantity:
100 sheets	$1188.00	Quantity:
Type 2
5 sheets	$165.00	Quantity:
10 sheets	$247.50	Quantity:
50 sheets	$781.00	Quantity:
100 sheets	$1485.00	Quantity:

UPS Red Shipping:	Domestic = $45.00 Foreign = $115.00