Purchase order form
Please use this page to generate an order form to include with your payment.
- Complete the contact information and select the product(s) you wish to purchase.
- Click the "Create order form" button to generate an order form.
- Print the order form.
- Mail the order form, along with your payment to the address printed on the order.
Please note: this information is NOT automatically sent to RxKinetics.
For faster order processing, you may purchase via credit card:
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