Med-Label, Inc. ORDER FORM

       
Bill to:    
     
     
     
     
     
     
       
Same as Bill to:    
Ship to:    
     
     
     
     
     
     
       
Customer Information:      
Customer Account #:    
PO#    
Name:    
Department:    
PHONE#:    
E-MAIL:    
Verify Email:    
Order confirmation by email:



   
SHIPPING: Med-Label Inc will prepay ground shipping and add to invoice unless otherwise noted below:
    
       
Fed-Ex or UPS collect (charge to your account)    
Expedited FedEx delivery request:    




   

 

QUANTITY REORDER #: DESCRIPTION UNIT PR TOTAL
         
         
      SUBTOTAL