ORDER FORM To Order TiterMax or related supplies, complete this form and Mail to CytRx Corporation in the United States at the address below, or for speedier processing, Fax this form to us at 770-447-8875, or call toll free at 1-800-345-2987, or at 770-368-9500 outside the U.S. Orders are processed upon receipt. Product Code Qty Unit Extension Price TiterMax 0.5 ml vial (1-11 vials) R-1 _____ $98.50 _______ 0.5 ml vial (12+ vials) R-1 _____ $85.50 _______ 1.0 ml vial (1-5 vials) R-2 _____ $185.00 _______ 1.0 ml vial (6+ vials) R-2 _____ $171.00 _______ 5.0 ml vial R-5 _____ $825.00 _______ 10 ml vial R-10 _____ $1,575.00 _______ TiterMax Gold 1.0 ml vial (1-11 vials) G-1 _____ $98.50 _______ 1.0 ml vial (12+ vials) G-1 _____ $85.50 _______ 5.0 ml vial G-5 _____ $465.00 _______ 10 ml vial G-10 _____ $825.00 _______ 20 ml vial G-20 _____ $1,575.00 _______ 1.0 cc All Plastic Syringe M1-1.0 _____ $ .20 _______ 3.0 cc All Plastic Syringe M1-3.0 _____ $ .15 _______ All Plastic 3-Way Stopcock M2 _____ $ 2.00 _______ Double Hub Emulsification M3 _____ $19.00 _______ Needle Kontes Pellet Pestle Motor M4 _____ $69.00 _______ 0.25 ml (1/4 cc) Glass M5 _____ $39.00 _______ Tuberculin Syringe TOTAL _______ Shipping Method Price Total UPS Red (Overnight) $20.00 ________ UPS Blue (2nd Day) $10.00 ________ UPS Standard Ground (Up to 6 Business Days) $5.00 ________ International Shipping (Cost Varies) ________ *GRAND TOTAL ________ [ ] Please send me more information about TiterMax Prices effective 15 May 1996 *Payable in US Dollars PO# _______________ Name of End User____________________ Bill To Ship To ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ Phone# _______________________ Phone# _______________________ Caution: TiterMax is an adjuvant for investigational use only in laboratory animals, or for tests in vitro. Not for use in humans. 154 Technology Parkway Technology Park/Atlanta Norcross, Georgia 30092 Toll free: 1.800.345.2987 Telephone: 1.770.368.9500 Fax: 1.770.447.8875