All Anaphora Discs customers are required to fill our our Terms, Conditions and IPR Order Form.

Please contact us if you need any help with this form or if you have any questions. 

The form is displayed below and can also be downloaded directly. This form can be filled electronically with Adobe Acrobat. Please fill out all 3 pages completely electronically or by hand, sign digitally or by hand, (scan if signing by hand) and email to or fax completed form to (877) 926-6224.

Download the form here: Anaphora Discs’ Client Order Form