Med-Label, Inc. ORDER FORM Labels, Label Guns, Label Printers & Label Supplies for the Hospital Marketplace Bill to: Ship to: Same as Bill to: Yes Name: Name: Address 1: Address 1: Address 2: Address 2: City: City: State: State: Zip: Zip: Phone: Phone: Customer Information: Customer Account #: PO# Name: Department: PHONE#: E-MAIL: Verify Email: Order confirmation by email: Yes No SHIPPING: Med-Label Inc will prepay ground shipping and add to invoice unless otherwise noted below: Fed-Ex or UPS collect (charge to your account) Expedited FedEx delivery request: First Overnight (by 8am next day) Priority Overnight (by 10:30am next day) Standard Overnight (by 3pm next day) QUANTITY REORDER #: DESCRIPTION UNIT PR TOTAL SUBTOTAL Thank you for your order!