First Name *  

Last Name *  

Company/Institution

Address *  


City *  

Prov/State *  
Select Alberta British Columbia Manitoba New Brunswick Newfoundland Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming
Country *  
Select Canada USA
Postal C./Zip *  

Language   
English Français
Type of Business   

Organizations / Office / University   
Chose... AGAT Laboratories Bishop's University CEGEP Beauce-Appalaches CEGEP de Chicoutimi CEGEP de l'Outaouais CEGEP Sorel-Tracy CEGEP St-Jean-sur-Richelieu CEGEP Ste-Foy Center for Addiction and Mental Health CHA CHUL CHUQ CNRC-Royalmount College Ahuntsic College Bois-de-Boulogne Commission Lester-B-Pearson Commission Scolaire de l'Estuaire Commission Scolaire des Navigateurs Concordia University Dalhousie University Dawson College École Polytechnique Guelph University Heritage College Hospital for Sick Kids Hôtel Dieu de Montréal INRS Lady Davis Institute Laval University Maisonneuve-Rosemont Hospital McGill University McMaster University Moncton University Montreal General Hospital Montreal University Mount St.Vincent University Queen's University Ryerson University Sherbrooke University Thrace Toronto Western Hospital Trent University University of Toronto University of Waterloo UQAC UQAM UQAR UQAT UQTR Wilfrid Laurier University York University - Other -
Phone 1 *Ext.
Home Work Cell.
Phone 1 Ext.
Home Work Cell.
Fax   

Email * (Essential to communicate with you.)

URL   

Ordering method *  
Select Purchase Order only Credit card only (Visa or MasterCard) Purchase Order and Credit Card (Visa or MasterCard)
NOTE: Purchase orders require banking information.
To buy via purchase orders, please download our [ Credit information form ], fill it and returne it to us by fax or regular mail.

Login Name*  
(at least 6 char.)
Password *  
(at least 6 char.)
Confirm password *  

Login Name and Password are used to access your personal record online.
Please write them down and keep them in a safe place.

Your Tekniscience's representative*  
Select Karine DesbiensMartin st-LouisMélanie BoisvertMichel St-LouisOtherPierre St-LouisRafiq Shaikh

* I have read the document [ Terms & Conditions ] and I agree to its entire content.
(This link will open in another window.)