Page 656 - Medco Sports Medicine e Catalog 2018

Order Form
1 Bill To NAME
ATTN:
STREET ADDRESS
CITY, STATE, ZIP
CUSTOMER NO.____________________________
See the pink box on the back cover of this catalog
2 Ship To
NAME
ATTN:
STREET ADDRESS CITY, STATE, ZIP
() () PHONE E-MAIL ADDRESS PHONE
() ()
E-MAIL ADDRESS
FAX
3 Payment Method o Charge to my credit card
o Bill our account
See the blue box on the back cover of this catalog
FAX INSTRUCTIONS
CREDIT CARD NO.
SIGNATURE
NAME OF CARDHOLDER
CREDIT CARD BILLING ADDRESS CITY
5 Your Order
o Check enclosed ooo
EXPIRATION DATE
Mo. Yr.
oo
_______________________________________
GSA Smart Pay Government Purchase Card
STATE ZIP
4 Key Code
P.O. #
QTY. ITEM NO.
DESCRIPTION PRICE EACH EXT. PRICE
Sales Tax1 (on subtotal) (AL, AR, AZ, CA, CO, CT, DE, DC, FL, GA, IA, IL, IN, KS, KY, LA, MA, MD, MI, MN, MS, MO, NE, NM, NJ, NY, NC, ND, NV, OK, OH, OR PA, RI, SC, SD, TN, TX, UT, VA, WA, WV, WI Customers)
Total Merchandise
Shipping & Handling
(see info at left)
Sub Total
TOTAL
1Every order must include applicable sales tax. If you are tax exempt, please fax your tax exemption certificate along with your order. SHIPPING AND HANDLING FOR ORDERS SHIPPING WITHIN THE CONTINENTAL UNITED STATES • $9.95 Shipping and Handling charge for order up to $90.00
• Shipping and Handling for orders over $90.00 is 12% of order value
• Delivery of all orders within the continental U.S is F.O.B. shipping point by ground delivery service. • Overweight/Oversized items may require additional charges; please call 800-556-3326 for a quote. • For orders shipped outside of the continental United States, please call 800-556-3326 for a quote.
6 To Order:
Call 24 Hours/7 Days
1-800-556-3326
Mail to:
25 Northpointe Pkwy, Ste. 25 Amherst, NY 14228
Order By Fax 1-800-222-1934
Order Online www.medco-athletics.com
Try our “Quick Order” online order form
Please see previous page for ordering info, terms, returns policy, and shipping and handling information.