Order Form

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 Addres


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