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Purchase Order Form

Full Name*
Company Name*
Clinic Name*
Shipping Address*
Phone Number*
Contact Email*
Billing Email*
Items for Purchase (copy and paste items from quote you received)*
Sub-total*
Items are drop shipped and pricing does not include shipping and HST.

Invoice will be sent once item has shipped.

2% processing fee for Visa.

2.5% late fee for payments over 30 days.

All freight shipments will arrive liftgate outside you will be responsible for getting into the building.

Keep all packaging until shipment has been unpacked and inspected

Shipment must be unpacked and inspected and damages reported with pictures of packaging and damage immediately

Save all packaging until equipment has been inspected
Terms and Condition*
- I have read the terms & condition
Signature*
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Phone
This field is for validation purposes and should be left unchanged.

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