Classic Health Supplies Ltd. Fax/Online Order Form

To order, fill out this form, then either

Print out the form and fax it to Classic Health at (780) 421-4507.
OR
Automatically email your order to Classic Health by pressing the Submit button below the form.

Client / Facility Name:
Person Placing Order:
Date:
Phone No.	( )
Email
Purchase Order No.

Product No.		Description:	Quantity:
Product No.		Description:	Quantity:
Product No.		Description:	Quantity:
Product No.		Description:	Quantity:
Other Information	Please enter any other information concerning your order here.