Order Form
An order form for Westgard products and courses.
Order Form
To Order any WQC Product:PRINT THIS PAGE OUT, COMPLETE THE FORM, AND SCAN IT, EMAIL TO This email address is being protected from spambots. You need JavaScript enabled to view it..
Call 608-833-4718 for more information (or if you want to use a hospital P.O.).
| Your Name | |||||
| Institution | |||||
| Title | |||||
| Department | |||||
| Street | |||||
| City | State | Zip Code | |||
| Country | |||||
| Business Phone | |||||
| Business Fax | |||||
| E-Mail Address | |||||
| Credit Card type (circle one) | VISA Mastercard American Express |
| Credit Card Number | |
| Expiration Date | |
| Cardholder (please print) | |
| Signature |
If there are any special shipping instructions (floor and office number, mail stop, etc.), or any comments or questions you'd like to add, please use this space below:
*WQC sends manuals via US Priority Mail; inquire for other types of shipping.
|
Discount coupons and offers on WQC products are only available through the use of the online store on the http://westgard.com website.Orders via mail, fax, and phone are not elligible for these specials. Furthermore, the Web Specials are available for the limited period stated with the offer. Approximately once every month, the Web Special will change. Once the time has elapsed on an offer, the product reverts to its original price as listed in the Catalog. |
|
Under $100 = $11.95 shipping & handling |
| International Shipping and Handling Fees to Asia, Africa, China, Hong Kong, India, South Africa, South America, Saudi Arabia and the Middle East (trackable packages) |
|
Under $100 = $84.95 shipping & handling |