Product Order Form






Products or services
Enter the name of the product or service, the quantity, hardware serial board number or any other information necessary to purchasing this product/service


Contact person
Person who we can contact about this order
Company name  
Telephone number
E-mail address
Order description  
Order number
Purchase Order number, order date, or other ID

Where to send this order

Please fill out this section so we can know whether to send your order to the company address or some other location.

Ship to contact person
Ship to company name
If being shipped to a company address
Shipping address
Must be a valid FedEx street address -- no P.O. boxes
Shipping address line 2
(Suite or room number)
ZIP/Postal code
Required if not the U.S.
Alternate telephone (mobile, etc.)
E-mail address


We will ship via FedEx unless other arrangements are made.
Your shipping account number
Please enter your FedEx account number.
Desired delivery date
Tell us when you need this order. Is it rush, or can you wait for our current shipping schedule?
Declared value for customs purposes Specify U.S. Dollars or Euros
Required if being shipped outside the U.S. Examples: "$412.34", or "412.34 dollars", or "€367,89" or "367,89 euros".
NOTICE: If you live outside the USA and you enter a Declared Value in this text box, Pangolin requires you to understand and abide by the customs procedures and regulations applicable for your country. The value that you enter in this box is related to customs duties and taxes that may be assessed when you receive the package. Entering an incorrect value in this box may delay package arrival or, in some cases, trigger penalties for entering the wrong amount. When in doubt, you should specify the same value that is used in the Total Payment Amount box below.
Any other special instructions


Because this simple page does not automatically calculate the total, you'll have to calculate the Payment Amount yourself. If you do not know the price, contact Pangolin by e-mail,  phone or fax, and we will compute the amount for you.

Enter total Payment Amount
Specify if the amount is Dollars or Euros

You must indicate U.S. Dollars or Euros. Examples: "$412.34", or "412.34 dollars", or "€367,89" or "367,89 euros".
You must fill in a Payment Amount if buying by credit card

Payment Method
Orders will not ship until payment is confirmed.
For details about shipping costs, guarantees, return policy and payment options, please see our Merchant Policy.

  Credit Card. Be sure to fill in the gray Credit Card Billing Information section below, then provide your credit card number by phone or fax.
Wire Transfer. Contact Pangolin for our wire transfer information including bank and account number.
Check in U.S. dollars drawn on a U.S. bank. Payment Amount above must be in U.S. dollars.
PayPal (we will issue an invoice to the email address listed above with instructions on how to pay via PayPal)
Other. Specify:

OPTIONAL -- for credit card purchase

Fill in this section if you chose "Credit Card" as your Payment Method above. For details about shipping costs, guarantees, return policy and payment options, please see our Merchant Policy.
Cardholder name
Name as it appears on the credit card
Required if buying by credit card
Cardholder billing address
and telephone number
Include street/box, city, state, postal code and country
Required if buying by credit card. Please enter all billing address information.
Card type Visa     MasterCard     American Express
Required if buying by credit card
Card number  
Required if buying by credit card
Expiration date  
Required if buying by credit card
Security Code  
Required if buying by credit card