New Customer Form - Veterinary Orthopedic Implants
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1Veterinary Orthopedic Implants
New Customer Form
Print Form
Email Form
Date:______________________
Name of Practice or Hospital: ______________________________________________
Ship to address: ________________________________________________________
City:__________________________________ State:___________ Zip:___________
Mailing address:
________________________________________________________
City:__________________________________
State:___________
Zip:___________
Phone: ______________ Fax: _____________ E-mail: _______________________
To save paper and postage invoices will be sent to you by email to fax the day your
order ships. CC customers receive a paid copy of their invoice. Net 30 receive the
invoice to be paid.
Send Invoices - Attn: ___________________________
Fax: ___________________
Email:
________________________________________________________________
Purchasing contact: ____________________________ PO#'s required? __________
Owner or Head Surgeon: _________________________________________________
Other Surgeons?
_______________________________________________________
Accounts Payable Contact: ______________________ Direct Fax? _______________
Credit Card: ____________________ Exp. Date: ______ 3 digit code on back: _____
Visa
or MC
Name as it appears on the card:_____________________________
Address where cc bill is sent:_______________________________________________
How did you hear about VOI? ______________________________________________
Type of screws you use? _________________________________________________
Surgeries you do? TPLO:
TTA:
Other: _____________________________
Comments/Questions: ___________________________________________________
______________________________________________________________________
We appreciate your business. Please let us know how we can be of service.
The VOI Team.
Phone: 800-375-1115
Fax: 866-327-8257
email:
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Parent category: Medical