|
Order Form
|
Please Print and Mail or Fax This Form
All information submitted, including the email address, will be kept confidential and will never be
divulged to a third party.
Medi-Vet offers only US FDA/EPA approved
medications.
|
|
Email: |
orders@medi-vet.com |
|
WebStore: |
www.medi-vet.com |
Phone Orders:
Fax Orders: |
(800) 668-9698 (Local: 985-875-7533)
(800)
640-3274 (Local: 985-875-7530) |
|
Postal address: |
Medi-Vet Animal Health
69142 Hwy 59, Suite E
Mandeville, LA 70471 |
| Name: |
|
| Business Name (if applicable): |
|
| Address: |
|
| |
|
| City, State, Zip: |
|
| Phone: |
|
| Email: |
|
Note: Prescription Medications Are
Available Only to Licensed Veterinarians, Pharmacies, Drug Companies and
Wholesalers. Prescription medications are labeled with an "Rx" in
our store.
|
Quantity
|
Product |
Cost |
Total Cost |
| |
|
|
|
| |
|
|
|
| |
|
|
|
| |
|
|
|
|
Louisiana Residents add 4.0%
|
|
|
|
See Shipping/Handling Rates Below |
|
Shipping Option |
|
|
|
TOTAL |
|
| Payment Method: |
Check
[ ] Money
Order
[ ]
Credit Card
[ ] |
| Credit Card Type |
Visa
[ ] MasterCard
[ ] AmEx [ ] Discover
[ ] |
| Card Number |
|
| Expiration |
|
| Signature |
|
Home /
Search |