Uniforms Scrubs Etc
You may use this form for fax or mail orders. Be sure to include your contact information.
If paying by check, please mail it along with a copy your order to the address below
2361 Newgate Drive
Phone:404.288.8554
Decatur, Georgia 30035-2421
Fax: 404.288.0495
Ship To: Bill To:
Name
Address
City
State
Zip
Tele:
Style
Size
Unit price
No Units
Total price
Credit Card Information Subtotal
Card Type Visa, Master Card, or Discover Cards
Card Number
GA Residents only 7% GA Tax
Name on Card
S&H
Signature
Expiration Date
Total