Medflight Order Form

 

Print and Return To:

Midwest Medflight
5305 McAuley Dr., Suite 311
Ypsilanti, MI  48197

ATTN: Merchandise Order

 

ITEM

SIZE

QUANTITY

TOTAL COST
       
       
       
       
       
       
       
SHIPPING CHARGES:              1-3 Items: $3.00                       4-9 Items: $5.00                       10+ Items: $8.00


SUB TOTAL:          _____________

SHIPPING:          _____________

TOTAL:          _____________

SHIP TO:                                                                                                              

NAME:    ________________________________________

STREET: ________________________________________

CITY:       ________________________________________

ZIP:          ________________________________________

PHONE:  _(_________)______________________________


* NO CASH, please. Check or money order payable to Midwest Medflight.

* Please allow 2 - 4 weeks for delivery.