If you place this order via this website, please do not send another form by mail or fax to Waters Philippines to avoid duplication of orders. Name     LastName First Middle Email Residence Address       City Municipality Province Zip Code Residence Tel. No./Fax No. Office Address       City Municipality Province Zip Code Office Tel. No./Fax No. Name of Waters Distributor (who convinced you to buy this product; if none, we will assign a distributor to handle your account) Please Deliver to: Home Office Other Delivery Instructions Product Model List Price* Qty. Mode of Payment: Cash (C.O.D.) Over the counter deposit Please call me, I am interested in : Lay-away plan Installment schemes (conditions apply) Credit Card payments (no surcharge) I would like to receive the latest updates about our products and promos of the company Payments may be made at any RCBC RCBC Account name WATERS PHILIPPINES RCBC Binondo Branch Acct. No. 1-109-54123-7 Please fax to us copy of validated deposit slip to facilitate