|
* * Fax Cover Sheet – Canadian Meds USA * * |
Thank You For Submitting Your Order |
[CMUSA] |
|
If you fax (instead of mail) your prescriptions to Canadian Meds USA in connection with placing your order, please use this form as a cover page for your fax. Please attach only one prescription per page and make additional copies of this form if you have more than one prescription. |
|
Prescription Order Fax Cover Page
Fax Number: 1-877-933-3625 |
|
|
Total Number of Pages (including this sheet)
|
Your Name: (as written on prescription)
|
Address: |
|
|
Home Phone: |
Birth Date: |
Number of Prescriptions you are faxing at this time:
|
|
Please attach your
Prescription
HERE
Thank you! |
|