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United States FAX Order Form

Note: The FAX Order Form is intended for United States orders. If you are located outside the United States, please contact your local Beckman Coulter Representative to make sure it is permitted in your area or situation.

Steps to Complete

  1. Click "FAX Order Form" (251 KB) .
  2. When you see the File Download dialog box, reperesented below, click Save or Open. Depending on your selection, follow the prompts to download or open the file.

    FAX_Order_Form_Download


  3. Please fill in all applicable fields on the downloaded form.
  4. Please Fax to the appropriate representative
      a. For United States Orders, please fax your order and PO (if applicable) to (800) 232-3828
      b. Outside the United States, please contact your local Beckman Coulter Representative to make sure it is permitted in your area or situation.