MEDIDS.COM MAIL AND FAX ORDER FORM

For this form to function properly, JavaScript needs to be enabled in your browser. MedIDs.com Mail/Fax Order Form for Non Personalized items listed below.
We deliver within the USA Only and accept Credit Cards listed below and USA Money Orders Only.
To Order By Mail or Fax: Select item under Product Description, TAB to select quantity. Then use your TAB key to get extended price. PRINT it, using either the print feature of your browser, or the PRINT button at the bottom.

Item -Select Product Below- Quantity Unit Price Extended Price

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Subtotal:

Shipping & Handling - Charges should be added automatically. If not (Click Here for the amount)

For Orders to PR, Guam, VI, APO's, FPO's Check here to INCLUDE additional $3.00 Shipping:

For USPS Priority Mail Service - 2-3 days (additional $4.00 shipping) check here :

How did you find us?

Check here If Louisiana Resident Sales Tax:

Total Amount (U.S. dollars):

Customer Shipping Address

First Name:

Last Name:

Company:

Address1:

Address2:

City:
State:

Zip/Postal Code:

Phone:

Email address:

Your Order Total Is:

If your above order total is $0.00 check the Quantity of item/s ordered.

Included below for Credit Card Charges

Credit Card Type:
Credit Card Number:
Expiration Date:
Security Code on Back of Card:	What's This?

If the Print Button does not work on your computer, click on "FILE" - and choose "PRINT" on your browser.
Mail a copy of this completed form with U.S. Money Order payable to "MedIDs.com" to:
MedIDs.com
2400 Cypress St., Su 50 - PMB 211
West Monroe, Louisiana 71291-4563
Or FAX a copy of above order to:(866) 908-8843

Your mailing address where you receive your monthly card billing statement, if different from the above mailing address.

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