EDQM Reference standards request

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European Pharmacopoeia Reference Standards

Please use this form to request a proforma invoice or a quotation for reference standards from the EDQM.
All fields with an asterisk (*) are required. We cannot fill your request 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 Request’ button below to send your request.

Customer information:

EDQM client code (1) : Your order ref : Date :

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 request for proforma invoice

To request a quotation (Please note quotations are only valid one month.)

Please complete using only information found in the EDQM Reference Standard Catalogue. Remember to check the availability of the reference standard before ordering.

Order code *	Reference substance *	Unit price *	Quantity (2) *	Extra charges code (3) *	Total goods (Euros)










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) A reference standard may include several individual vials (see catalogue), in such instances do not order the total number of vials.
(3) Extra delivery charges and price.
The prices quoted in our catalogue are exclusive of duties and taxes. Extra delivery charges will be applied, please see our catalogue for details.

Thank you for your request.
Press the 'Submit Request' button below to send in your completed request. You will receive a confirmation by email when we have processed your request.

* What is the sum of : 4 + 8 ?

7 allée Kastner, CS 30026, F67081 Strasbourg, France - Tel. +33 (0)3 88 41 30 30 - Fax +33 (0)3 88 41 27 71
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