Rxwholesale Inc Quote and Inquiry Form

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License Information

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Will you Fax License to:	(718) 392-9250 for authentication? Yes \|\| No

Shipping Information

Shipping information same as above information

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Drug Information:

Drug Name:	Strength/Size	Type:	Quantity:
Drug Name:	Strength/Size	Type:	Quantity:
Drug Name:	Strength/Size	Type:	Quantity:
Drug Name:	Strength/Size	Type:	Quantity:
Drug Name:	Strength/Size	Type:	Quantity:

We do not fill prescriptions for Controlled Substances!!!. All prices quoted, and orders shipped, are billed and shipped FOB New York City . No returns may be accepted for drugs and medication, in accordance with Federal and State regulations governing prescription drugs and medications. All Prescriptions received by Phone, Fax, E-Mail, or Mail, from Patients, Physicians, Clinics, Hospitals, or other health care professionals, are received by our Pharmacy, in New York State, and are subject to being filled under the jurisdiction and laws and regulations of the State of New York and of appropriate Federal regulations if applicable. Delivery of your medication, regardless of the address you designate will be construed to have been made in the State of New York by our giving your order to Airborne Express, DHL or FedEx for delivery to you. Your transmission to us, of your prescription, and request to have the medication shipped to you at any designated address is an acknowledgement that you have read this notice and agree that New York State and Federal laws and regulation, govern and control, as to this prescription order, and will be subject only to New York State law and jurisdiction.

Toll Free Phone in the USA (800) 798-7248 (800) 764-3648 TOLL FREE FAX# IN THE USA 1-(866) 843-4154
Alternate Phone (516) 467-2500 FAX (516) 467-2539 (516) 467-2541		US FDA APPROVED DRUGS ONLY!!!!!!!
RxUSA Wholesale Inc. Wholesale Pharmaceutical Distributor 81 Seaview Blvd. Port Washington, NY 11050		RxUSA Administrative Office: RxUSA Inc. 81 Seaview Blvd. Port Washington, NY 11050
WHOLESALE PHARMACEUTICALS DUN AND BRADSTREET # 06-180-9963 RXUSA INC. CORPORATE PARENT DUN AND BRADSTREET # 10-797-9960

*Always call for current pricing and volume discounts. We do not fill any drug orders for any controlled substances. All orders received by Phone, Fax, E-Mail, or Mail, from , Physicians, Clinics, Hospitals, or other health care professionals, are received by our Pharmacy Distributor in New York State, and are subject to being filled under the jurisdiction and laws and regulations of the State of New York and of appropriate Federal regulations if applicable. Delivery of your order, regardless of the address you designate will be construed to have been made in the State of New York by our giving your order to the U.S.P.O. or Airborne Express for delivery to you. Your transmission of your prescription drug order and request to have the medication shipped to you at any designated address is an acknowledgement that you have read this notice and agreed that New York State and Federal laws and regulation as to this prescription order will be subject only to New York State law and jurisdiction.