Order Form
P.O. Box 630414
Little Neck, NY  11363  USA
Tel: 1-800-635-2452
Fax : 718 352 2984
E-mail: [email protected]
Customer Information
Physician or Representative:
Practice/Clinic/Org Name:
Street Address:
City, State, Zip:
Country:
Phone:
Fax:
Email address:
Payment Method
Check (made payable to Advanced Meditech International)
Please bill me* - Net 30
*(Existing accounts or satisfactory D&B rated firms, universities, & government agencies only)
If using a PO #, please fill out this order form.
Visa    Master Card    American Express   
Card number:
CVV Code:
Expiration date:
Signature:
Items Ordered
Add Item
Item # Qty. Description Unit Value Total Value
Subtotal:
In New York Only, Add 8.875% State Sales Tax:
$11.50 Ground Shipping:
International Orders Add $47.50 More
ORDER TOTAL:
In most cases, we ship less than 24 hours after receiving your order with payment. Shipment to AK & HI via FedEx add $47.50; to International destinations via International Express Mail (for a charge of $59.00). If you have special shipping needs or requirements, please contact our order department to make alternative arrangements. Please note that the shipping rate is based on product weight. For most International destinations, standard shipping on items up to 1 kilograms is via USPS International Express Mail for $59.00 USD. Over 1 kilograms, shipping will be at actual cost.
Comments or Special Instructions