Crest 2015 Catalog With Prices

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272 phone: 1-800-328-8908 | fax: 1-800-369-9207 | | 2015 | F35
Crest Healthcare Supply®
Order Form
CIRCLE PAYMENT METHOD: CHECK WITH ORDER PLEASE SEND INVOICE (subject to credit approval) C.O.D (U.S. FUNDS ONLY)
CREDIT CARD: DISCOVER, MASTERCARD, VISA, AMERICAN EXPRESS
CIRCLE SHIPPING METHOD: GROUND 1-Day 2-Day 3-Day OTHER
l.
**Not required if your Tax Exempt Certificate is on file at Crest.
***Shipping charges are pre-paid by Crest and added to your invoice. If payment is
"check with order," call our toll-free number for shipping charges.
Note: Customer is responsible for any additional taxes or fees associated with
international orders.
*Prices may change without notice.
Sub total
CA, FL, MN residents add applicable
sales tax**
Shipping charges ***
TOTAL AMOUNT
QTY. PART NO. COLOR DESCRIPTION UNIT PRICE* TOTAL
(when applicable)
Order By Mail:
Crest Healthcare Supply
195 Third Street South
PO Box 727
Dassel, MN 55325-0727
Order By Fax:
Fill in the order form
and fax to our toll-free
Fax:1-800-369-9207,
available 24 hours.
Order online:
Order by email:
Order by phone:1-800-328-8908
Monday-Friday 7:00 a.m. until 5:00 p.m.
(Central Time)
*Minimum order value is $25 Excluding shipping & handling.
*Minimum $25 order
Facility Name ____________________________________________________
Customer # ___________________________________________________
Address _______________________________________________________
City ___________________________ State __________________________
Zip Code _______________________________________________________
Name ___________________________________________________________
Dept. ____________________________________________________________
Phone __________________________Fax __________________________
Email ___________________________________________________________
Facility Name ___________________________________________________
Address ________________________________________________________
City ___________________________State __________________________
Zip Code _________________________________________________ _____
Phone _________________________ Fax __________________________
C/O _____________________________________________________________
___________________________________________________________________
__________________________________________________________________
___________________________________________________________________
Promotion Code # _______________________________
Purchase Order # ________________________________
Credit Card # ____________________________________
Expiration Date __________________________________
Credit Card Security Code _________________________
Authorized
Signature _______________________________________
Date_____________ MN Tax Exempt # ______________
BILLING INFORMATION SHIPPING INFORMATION
FOR CREST USE ONLY:
UPS or FedEx Account # ________________________________________________________________________________________
CHECK IF SAME AS BILLING INFO