This page contains a number of forms that you may find useful when ordering with eGeneralMedical.com. These forms are all in PDF format, and require that you have Adobe Acrobat installed on your computer. After you download the forms, you may either complete them on your computer in Acrobat and then print them out, or you can print them and fill them in by hand. After you have completed filling in the forms, please fax them to us at: 1-206-339-6451.
|Order Form: || |
If you are not able to place an order online using our shopping cart system or place an order by phone, you may download this order form and fax your order to us. You will receive an email confirming your order after we receive your fax.
|Credit Card Authorization Form: || |
All domestic (USA) orders over $200 and all international orders require this Credit Card Authorization Form to be filled out and faxed to us at (01) 206-339-6451. We must receive this form before we can process your order.
|Prescription Drug & Device Request Form: || |
If you are trying to purchase an item that requires a prescription (either a prescription drug or a device), you must dowload this form and have your physician complete it and fax it to us before we can process your order. Prescription drug and device requests can only be submitted by a licensed physician.
|Medical License Request Form: || |
In order to sell prescription drugs and/or equipment to physicians, we must have a copy of their state license and DEA license on file. Please complete this form and fax it to us along with copies of the required licenses so that we may process your order. You will only have to complete this process one time, as we will have these records on file for future orders.
|Package Not Received Form: || |
If you received shipping confirmation for your order but have not yet received your package, you may file a "Package Not Received" form with us.
|USPS Domestic Claim Form: || |
If your package was shipped via USPS and was either received damaged or lost in the mail, please file a claim by completing this form and sending it to USPS. You may submit this form in addition to the "Package Not Received" form above, if applicable.
|Net 30 Financing Credit Application: || |
We offer Net 30 financing to universities and companies who prefer to be invoiced for their purchases instead of paying up front. To apply for financing options, please complete this form and fax it to us.
|Third Party Freight Billing: || |
If your company has a UPS account that you would like your shipping charges billed to, please complete this form and fax it to us.
|eGeneral Medical Inc. Tax Exempted Status: || |
eGeneral Medical Inc. is tax exempted as a wholesale trade reseller and have enclosed our Tax Exempted Resale Certificate. We also have authority to accept donations.
|North Carolina Tax Certificate of Resale (form E-590) || |
eGeneral Medical Inc. Certificate of Resale, North Carolina Sales and Use Tax Division, Form E-590
|eGeneral Medical Inc. Dept. of Agriculture License for Prescription Drugs || |
eGeneral Medical Inc. North Carolina Department of Agriculture and Consumer Services - Food and Drug Protection Division. Prescription Drug License
|eGeneral Medical Inc. Device & Medical Equipment Dispensing Permit || |
eGeneral Medical Inc. North Carolina Board of Pharmacy Device & Medical Equipment Dispensing Permit.
|eGeneral Medical Inc. Request for Taxpayer Identification Number and Certificate (W-9) || |
eGeneral Medical Inc. Request for Taxpayer Identification Number and Certificate (W-9).