Welcome to medi-vet Animal Health

Pet Medications and Pet Supplies
Order Form

When to use this Order Form

  • When you feel uncomfortable about submitting your credit card information online using our shopping cart .  Just fill out the "Order Form" below, and then fax or mail it in. 
  • All information submitted will be kept confidential, including email address, and will never be divulged to a third party.
Email: Orders:  orders@medi-vet.com
Phone Orders:
Fax orders:		 (800) 668-9698  (Local: 985-875-7533)
(800) 640-3274   (Local: 985-875-7530)
Postal address: Medi-Vet Animal Health
71345 Ellis Road
Covington, LA 70433

Personal Information

Name:
Email:
Billing Street Address:
Apt. or Suite:
City: 
State:    Zip/Postal Code: -
Country:

Home Phone (include area code): 
Work Phone (include area code):
 

Shipping to a Different Address?

Name (if different):
Address:
Apt. or Suite: 
City: 
State:       Zip/Postal Code:
Phone (include area code):

Products Ordered

Product ID

Description

Qty

Price

 Extension

Subtotal:

  Louisiana residents add 4% Sales Tax:     

Shipping Rates

Total:
Customer Status
 Repeat customer of Medi-Vet.com
 First time customer of Medi-Vet.com

Credit Card Information:

______________________________________________________________________________  exp date:_________

Using Our Secure
Shopping Cart		 If you choose to order using the "Order" buttons on each product page, your information will be submitted in a save and secure, encrypted form. All personal information is entered on a secure server and kept confidential.  In respect to your privacy, your information, including email address, will never be divulged to a third party. Back To Top

medi-vet.com

71345 Ellis Road, Covington, LA 70433
Telephone: (800) 668-9698    Fax: (800) 640-3274
http://www.medi-vet.com

Questions?  info@medi-vet.com

Copyright © 2008 Medi-Vet Animal Health Care. All rights reserved.
Revised: September 09, 2008.