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International Chemical Reference Substances (ICRS)
Please use this form to confirm a proforma or quotation or to place an order for ICRS from the EDQM. All fields with an asterisk (*) are required. We cannot fill your order without this information. Please ensure the information is correct. If the delivery address is DIFFERENT to the billing address, it is very important that you tell us. When you have completed the form, please press the 'Submit Order' button below to send your order.

Customer information:
EDQM client code (1) :     Your order ref  :     Date  : 
Are you a National Control Authority/Laboratory?(Please tick)*Yes  No  
BILLING ADDRESS
Company name* 
Address line 1*
Address line 2
City*
Postcode*
State (USA only)
Country*
VAT N° (in EU only)
Contact name*
Position
Tel* (incl country code)
Fax.
E-mail*
DELIVERY ADDRESS (If different from billing address)
Company name 
Address line 1
Address line 2
City
Postcode
State (USA only)
Country
VAT N°(in EU only)
Contact name
Position
Tel (incl country code)
Fax.
E-mail

I wish:
To confirm a proforma invoice
Your EDQM proforma reference (PF No.)*: 
Date of proforma invoice*: 
To confirm an order for which I received a quotation (Please note quotations are only valid one month.)
Your EDQM quotation reference (Q XXXX)*: 
Date of quotation*: 
To place an order
Remember to check the availability of the standard before ordering.
Order code * Reference
substance *		 Unit price * Quantity
*		 Total goods
(Euros) (2)
Total (Euros) 

Comments or additional information:


(1) If you have ordered with the EDQM before, you should have received an EDQM client code on your invoice.
(2) Extra delivery charges and price.
The prices quoted in our database are exclusive of duties and taxes. Extra delivery charges may be applied, please see our catalogue introduction for details.

Thank you for your order.
Press the ‘Submit Order’ button below to send in your completed order. You will receive a confirmation by email when we have received your order. You will receive another confirmation by email when your order has been shipped.

* What is the sum of : 8 + 7 ?


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