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Standard parcel charges will apply to all ground shipments*† and will be calculated at time of order. For non-credit card orders, please call customer service to obtain shipping charges.
* Additional charges may apply; please refer to ordering information provided in this catalog for complete details.
State Zip
† NOTE: Due to escalating fuel surcharges from our freight carriers, we are now forced to pass on a fuel surcharge for all ground orders. We reserve the right to modify the surcharge as market conditions change.
PRODUCT NUMBER PRODUCT DESCRIPTION PRICE EACH TOTAL ) ) State Zip Name (Please Print)______________________________________________
Signature____________________________________________Date_______ Charges will not be processed until a shipment is made.
Before you begin, please copy this order form to use again and again.
3 Method of Payment (Terms — Net 30 days):
Check (Payable to Patterson Medical) Bill our account: Purchase Order Number_____________________ Credit Card:
Visa Card Account Number: MasterCard Discover AmEx Expiration date____________
1
Every order must include applicable sales tax. If you are tax exempt, please fax your tax exemption certificate along with your order. If you are unsure about your sales tax, please contact customer service.