A Division of Diversified Healthcare Consulting

PO Box 844

Mustang, OK 73064

 

Order Form

 

Catalog #

Product Description/Title

Unit Price

Quantity

Price
         
         
         
         
         
         
Sub-Total  

Oklahoma Residents add 8.85% Sales Tax

  

Shipping & Handling *

  

Total

  
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Purchase Order Number: Phone:
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Print this order form for use by your agency for corporate purchases.

Include a company purchase order with business letterhead and signature of an authorized agent.