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Printable Order Form
Last Updated: 02/20/2014
Please click on attachment for a Print Friendly Order Form.

Medi-Vet Order Form

Mail, Fax or Email This Form
All information submitted, including the email address, will be kept confidential and will never be divulged to a third party.

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 and Pharmacies. Prescription medications are labeled with an "Rx" in our store.

Quantity

Product

Cost

Total Cost

Louisiana Residents add 4.0%

Please See Shipping/Handling Rates

Shipping Option

TOTAL

Comments:

Payment Method:

Check [ ] Money Order [ ] Credit Card [ ]

Credit Card Type

Visa [ ] MasterCard [ ] AmEx [ ] Discover [ ]

Card Number

Expiration

Signature

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Attachments:   07/16/2013: Medi-Vet Order Form.docx


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