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A division of the American Chemical Society
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  Computer Readable Services Order Form

Customer Requesting Information:

Name __________________________________________________________________________________________
Organization ____________________________________________________________________________________
Address ________________________________________________________________________________________
          ________________________________________________________________________________________
          ________________________________________________________________________________________
Telephone __________________________________________                          Telefax _______________________________
                                                                              Client's Reference Number_______________



Payment Information:                   Bill Me        Purchase Order # _______________________________________
                                       VISA           MasterCard              American Express
                                       Expiration Date _______________________
                                       Credit Card Account # ___________________________________________________


Computer Readable Services

CAS Computer Readable Service provides substance identification of input data for a large number of chemical
substances. A separate form should be used for each type of input. More than one output may be selected for a
given input. Complete the REQUIRED use of data/comments section below.

Input: (Choose only one)                                           Output: (Choose all that apply)

 Chemical Names                        Qty: ___________            CASRNs
 CASRNs                                Qty: ___________            CA Index Names
 Connection Tables--SDfile             Qty: ___________            Synonyms
                                                                   Molecular Formulas
REQUIRED: Use of Data/Comments ______________                      Structure diagrams (hardcopy)
_____________________________________________                      Substance definitions
_____________________________________________
_____________________________________________

A signature below is required before the requested Computer Readable Service will be performed. This
acknowledges acceptance of the CAS Client Services Terms and Conditions and CAS Information Use
Policies.

Authorized Signature _______________________________________                         Date ________________________




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