Fabco  Order Form
 
Disclaimer:
There is no automatic error checking in this form in terms of cost of the items, totaling up the costs, etc., however upon receiving your order we will check it and contact you to confirm all information. In addition, as this is not a secure channel any credit card information sent is done at the risk of the sender. We plan to have both automatic error/information checking and secure credit card transactions in the near future.


First Aid Bandage Company
3 State Pier Road New London, CT 06320-5817
(860) 443-8499 Toll Free: (888) 813-8214 Fax: (860) 442-8699

This is our first order     We have ordered before

    Ship To:

     Sold / Bill To:
    Purchase Order #:

     Date Needed:
    Ordered By:

     Phone #:

     Fax #:
Product
Code		 Quantity Product
Description		 Unit
Price		 Extended
Cost
All goods are shipped FOB destination by ground service within the 48 contiguous states. Express delivery service surcharges and/or shipping charges will be added for express service or delivery to other destinations.

    Credit Account ID#:

Subtotal
Other
Charges
Total

  Credit Card:     Visa     Master Card
 
  Card Number:  
  Expiration Date:  
  Name on Card:  
  Cardholder's Zip Code:  


Please be sure to read our Terms and Conditions.

-    Fabco Home    -    Order Form    -    Alphabetical Product Index    -