| MedBanner Network |
| ECM Corporation home page | Pricing and Ordering |
| Order Form - Printout | Order by phone: |
1-360-341-6788 |
| Please print out and fill in. | Order by FAX: |
1-360-341-3676 |
| Terms: 30 days | Order by mail: |
6111 Cultus Bay Road Clinton, WA 98236 |
| Order Contact: Name:________________________________________ E-mail:_______________________________________ Phone:________________________________________ |
| Bill to: Name:_____________________ Attn:______________________ Address:___________________ Address:___________________ City:______________________ State ZIP:__________________ |
Bill to: Name:_____________________ Attn:______________________ Address:___________________ Address:___________________ City:______________________ State ZIP:__________________ |
| P.O. Number: ___________________________ |
Ship Via: _________________________ |
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