A COSMETIC AID FOR HEALTHIER LOOKING HOOFS, SKIN AND HAIR COAT

US Government Personnel Only!  Please fill out the order form below and click on the submit button located at the bottom of this page. Your order may be telephone verified.

If you have any questions or comments, please fill out the comments section at the end of this order form and a representative will contact you shortly.

If you have any questions regarding your order, please call 1-703-690-3744, or e-mail: info@usamediainc.com.   *Indicates required information!        Thank you for your order!

Please provide the following contact and order information:

*Purchase Order No.

(You may use today's date)
*Organization
*First Name
*Last Name
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*City
*State/Province
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*E-mail  Your e-mail address will not be used for solicitation purposes.

Please provide the following ordering information:

One Free Evaluation Sample to Authorized Government Personnel Only. Offer limited while quantities last. Place an X in the box to the left.   May be a 22-oz Gel or Spray. MedEquine® Sample Free
QTY DESCRIPTION   PRICE
1 Case. 6 Units 22-oz. MedEquine® SPRAY BOTTLES $270.00
1 Case. 6 Units 22-oz. MedEquine® GEL BOTTLES $270.00
SHIPPING METHOD: Please select only one. PRICE
UPS/FedEx Ground $15.00 per case
UPS/FedEx 2-Day Air $23.00 per case
UPS/FedEx Next Day Air $28.00 per case
*Shipping prices will vary depending on quantity ordered.

Total Order Cost:                  $        (includes shipping cost)
SHIPPING ADDRESS
*Street Address
Address (cont.)
*City
*State/Province
*Zip/Postal Code
PAYMENT OFFICER   (If different from contact information.)
First Name
Last Name
Street Address
Address (cont.)
City
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IF YOU WANT A PRINTED COPY OF YOUR ORDER FOR YOUR RECORDS YOU MUST PRINT YOUR ORDER PRIOR TO CLICKING ON THE SUBMIT BUTTON.

    


 

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