Oxis International

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For orders within the United States, please call our
Sales Specialists at: 800-547-3686

Outside the United States, please click here to find
an Oxis Authorized Distribuor located near you.

For orders within the United States, please fax our
Sales Specialists at: 650-212-2569

Outside the United States, please click here to find
an Oxis Authorized Distribuor located near you.

Click here to download our Fax Order Form

Acrobat Reader Required

Email us at:

Postal Mail us at:

OXIS International, Inc.
323 Vintage Park Dr, Suite B
Foster City, CA 94404-1136
USA

OXISRESEARCH PRODUCT ORDER FORM

Submitting this form sends an email directly to an Oxis International Customer Service Representative who will contact you to complete your order.

(Please do not include Credit Card information in this unsecured form)

* = required information

Phone*
Order #
FAX
E-mail*
BILLING ADDRESS
Name*
Organization*
Address 1*
Address 2
City*
State/Province
Zip/Postal Code*
Country*

SHIPPING ADDRESS
Shipping Address same as Billing Address?
Name
Organization
Address
Address 2
City
State/Province
Zip/Postal Code
Country

QTY	DESCRIPTION

NOTES: