Refill Form

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ClassicDrugStore
Phone 1-800-707-9980 Fax 1-800-707-9980

REORDER FORM

Instructions:-

1. Please fill this form.
2. Provide your Contact Information & order Information.
3. Take print out & mail us.

Your Name

Address

City

State

Phone No.

Zip Code

Height

Weight

Medication being ordered	Strength/Dose	Quantity	Generic substitution	Price (US$)










			Sub Total:	$
			Shipping:	$
			Total:	$

                         Thank you for ordering from ClassicDrugStore
                        To reorder please mail this form .
                        Please allow for 7-14 days for shipping time.