Mail Order Form

MAIL ORDER FORM FOR CREDIT CARD, CHECK OR MONEY ORDER
Please complete this order form print it out and mail it to:

Toll Free 866-468-7739
Global Medical Systems, Inc.
Internet Order Processing
660 Baker Street, Suite 350
Costa Mesa, CA 92626 USA

Fax 714-432-7116
If paid by check or money order,
make check or money order payable to:
Global Medical Systems, Inc.
* California residents, please add 7.75% sales tax.

Name and Credit Card Information	Qty	Select Product
Name:
Address 1:
Address 2:
City:
State/Prov:
Zip Code:
Country:
Phone:
E-Mail:
Credit Card:
Card No:
Name on Card:
Exp. Date:

For Single Tests Buy At Least 3 In Any Combination For Best Price


Buy 1-2 at $2.40 each	Buy 3-4 at $2.35 each	Buy 5-8 at $2.30 each	Buy 9-12 at $2.25 each

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