FAX to 315-339-7107 or mail to AMMTIAC, 201 Mill Street, Rome NY, 13440-6916. Credit cards (VISA, AMEX, MasterCard) are accepted for purchases of $25 and up. All Non-US orders must be accompanied by a check drawn on a US bank.

1. Ordered By: Please include phone & fax information.
Name ___________________________________________________
Address _________________________________________________
City ______________________  State __________  Zip ___________
Phone (____)__________________  Fax (____)_________________
E-mail Address ___________________________________________

2. Ship To: Fill in only if different than ordering address.
Name ___________________________________________________
Address _________________________________________________
City ______________________  State __________  Zip ___________

3. Orders: Please Print Clearly.
  Product Code Qty. Description Item Price Total Price
1          
2          
3          
4          
5          
Subtotal  
Click Here for S&H options.    Shipping and Handling  
Total Amount Enclosed  

4. Payment Method:
   Check (made payable to Alion Science and Technology/AMMTIAC)   Purchase Order, (Attach)
   MasterCard  VISA  AmEx
 


Card Account Number: ______________________________________
Card Expiration Date: _____/_____
Customer Signature: _______________________________________
Credit card billing address if different from above:
Your Name: ______________________________________________
              (As it appears on your credit card)
Billing Address: ___________________________________________
City ______________________  State __________  Zip ___________