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Order / Quote Form

Wholesale

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If you are unable to find a particular medicine on the wholesale chemist.com site please complete this form and will we e-mail you a quote

If you accept the quote and would like to order, reply to the quote e-mail and further information will be given to you.

Company

Contact Name

E-mail Address

Confirm E-mail Address

Telephone (include country and area code)

Fax (include country and area code)

Address

List all the products and quantities you would like a quote for.

Preferred Terms of Trade

Special Instructions

By submitting this form you acknowledge that
you have read the Terms of Trade Document

	All matters and transactions in relation to this site are governed by the laws of New Zealand and will be settled in New Zealand under New Zealand law.
	Wholesale Chemist is a division of IT Pharmacuetical Supplies Ltd Email: service@wholesalechemist.com Website: http://www.wholesalechemist.com Postal Address: PO Box 1011, Tauranga, New Zealand Street Address: 94 2nd Avenue, Tauranga, New Zealand Phone: +64 7 571 2046 Fax: +64 7 571 2013

	Copyright 1999, 2000 by IT Pharmaceutical Supplies Ltd.