Please print this form, complete, and fax it to Tomtec at (203) 248-5724 with your company Purchase Order Form. Thank you.
If you have any questions or need assistance filling out this form please contact a Tomtec Customer Service Representative. pdf version
96 Well Custom Reservoir Form
Date:
PO #:
Bill To:



Ship To:



Phone:
Fax:
Quantity:
Date Required:
Catalog Number: 196-130-XX
Outer Height of Reservoir: 1.90 inches
Outer Height of SV Reservoir: 1.45 inches
Inside Depth: 1.56" 450µL instruments
Inside Depth: 1.12"
60µL instruments
Other Height:
please specify
Type of Bottom:
please check one
 Flat
Dimpled
"V"
Note: If you are ordering "V" bottom reservoirs, please contact a Tomtec Customer Service Representative to assist you in filling out this form.
Please mark the diagram below, outlining the footprint for the customized reservoir.
For best results use a thinline black felt tip marker.