Page 62 - Canada 2017

Ordering Information FAX TOLL-FREE 1-800-760-1454
ORDER FORM (FAX-FRIENDLY) PHOTO COPY THIS PAGE
1- Bill to:
Facility:
Attn:
PO #:
Street or PO Box: City:
Postal Code: Acct. #:
Province:
3- Additional Information:
Person Placing Order:
Dept:
Phone No.: Fax No.: Today's Date:
Email Address:
2- Ship to:
Facility:
Attn:
PO #:
Street or PO Box: City:
Postal Code: Acct. #:
Province:
4- Method of Payment:
r 30-Day First Healthcare Products Account
r Credit Card
r Visa r Master Card r American Express Card #: ________________________________ Exp.Date: ______________________________ Name of Cardholder: ______________________ Email Receipt: r Yes r No
5- Ordering: To avoid delay, be sure to fill in all necessary information, including colours, etc.
HOW MANY
UNIT Ea., Roll, Cs.
SHIPPING INFORMATION: All merchandise is F.O.B. shipping point. For further shipping and freight terms information, please call.
Please indicate whether the items you are ordering are SIDE-OPENING or TOP-OPENING style (when appropriate).
ITEM NUMBER
COLOUR
DESCRIPTION
For binders, please specify 2, 3, or 5 rings
UNIT PRICE Per Ea., Cs.
TOTAL PRICE Dollars Cents
MERCHANDISE TOTAL
SHIPPING/HANDLING
TOTAL
61 PHONE: 1-800-265-6613 | FAX: 1-800-760-1454 | EMAIL: info@firsthealthproducts.com | www.firsthealthproducts.com