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Request form for Educational Material

By filling out this form (below) it allows us to send you an E-mail with a User Name, Password and Instructions on how to download the movie from our FTP (File Transfer Protocol) Server.
(NO Programs Required. Can Access it Through The Internet Explorer)

Title :

First Name :

E-Mail :

Last Name :

Phone # :

Address :

Fax # :

City/Town :

Province/State :

Postal/Zip Code :

Country :

Associated With:

Name of Institution :

Department :

Website :


       

Ship To Information

(Fill The Form Below if You Would Like The Material Shipped To You Instead)

Title :

Name :

E-Mail :

First Name :

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Address :

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Country :

Associated With:

Name of Institution :

Department :

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Send product brochure(s) Is also available online "Brochure".
Send product poster (22"x17")
Sample Economy Edition / CD-Rom / 64167-00010-S
Sample Economy Edition / Video Tape / 64167-00011-S
Presentation Folder with CD-Rom / 64167-00017-S *
Presentation Folder with Video Tape / 64167-00018-S *
  * Includes; Cover Letter, Business Card CD-Rom or Video Tape,
              Brochure, Uses Guide, Warranty Card
Have a consultant contact me

Ship To Information:

Name :

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Customer - COMMENTS OR SPECIAL INSTRUCTIONS

 
 
 

Retail Outlets

(i.e. Pharmacies and Drugstores) in Western Canada , may purchase
our products, - quoting the following information and order numbers through
ASENDA, Pharmaceutical Supplies Ltd. in Richmond BC

Telephone
Local; 604-279-2520 or toll free; 1-888-440-5440

Fax
Local; 604-279-2521 or toll free; 1-877-529-2299

Additional product information can be found in this web site or contact us by E-mail;

Info@InjectionLocator.com

 

INJECTION LOCATOR  

Universal Bar Code & Order #’s

(ENGLISH)

 

BAR CODE

PRODUCT

MEDIA

ASENDA#

 

64167 – 00010

ECONOMY EDITION

CD-ROM

700010

 

64167 – 00011

ECONOMY EDITION

VIDEO TAPE

700011

 

64167 – 00012

EXECUTIVE EDITION

CD-ROM

700012

 

64167 – 00013

EXECUTIVE EDITION

VIDEO TAPE

700013

 

64167 – 00015

EXECUTIVE CASE

------------------

----------------

 

64167 – 00016

17 X 22 INCH POSTER

------------------

700016

 

64167 – 00017

INFORMATION FOLDER

CD-ROM

700017

 

64167 – 00018

INFORMATION FOLDER

VIDEO TAPE

700018

 

64167 – 00019

50 BROCHURES

------------------

700019

 
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