Quick Order Form

Please Complete the Fields Below to Place an Order

**All new users are set up with prepayment terms until an account has been established, provided we receive credit references. Credit cards or prepayment is required, please provide correct contact information. If you are using a company account, please provide the correct account number & company name.

***Orders must bill and ship within the United States; no exports.

Registered Dwyer Instruments, Inc. web users may login to their account to skip some entry of the below information


Login To Your Account


Please complete all required fields

Contact Information

First Name*:
Last Name*:
Phone*:
Email Address*:
Purchase Order No.:

**For Your Protection, Credit Card Numbers Cannot Be Entered On This Form

Please contact me for my credit card information:
Dwyer Account Number:

Billing Information

Company Name/Individual*:
Address*:
Address 2:
City*:
State*:
ZipCode*:

Shipping Information

Shipping Address Same as Billing:
Company Name/Individual*:
Address*:
Address 2:
City*:
State*:
ZipCode*:
ATTN/REF:
Ship Via
Ship Method - Other:
Collect No.:
Partial Ship OK?: YES NO

Order Information

Part Number:
Quantity:
Part Number:
Quantity:
Part Number:
Quantity:
Part Number:
Quantity:
Part Number:
Quantity:
Part Number:
Quantity:
Part Number:
Quantity:
Part Number:
Quantity:
Part Number:
Quantity:
Part Number:
Quantity:
Additional Information:
*: Required Field
Taxes and shipping charges may be added to your order. You will receive an email acknowledgement within 24 hours.

You may wish to print this page for your records.

Dwyer cannot guarantee that items will ship on the same day they are ordered via this website.
If this is a critical shipment, please telephone +1.800.872.9141.

If you have any questions about your orders, please email orders@dwyer-inst.com or call 219.879.8868 for customer service.