Order Form

NEW CUSTOMERS:
Please note that prior to dispatch of goods we require payment by cheque, BACS or credit card.
For details please call 0845 330 7556 and choose option 2.

To open an account with us, please complete our credit application form. Please send your payment and/or completed form to:

TRB Chemedica (UK) Ltd,
Med IC3,
Keele University Science Park,
Keele,
Staffs,
ST5 5NP,

fax: 0845 330 7557,
email: sales@trbchemedica.co.uk.
Title
Contact Name
(Prescribing Clinician)
 
Delivery Address:
Company Name *
FAO (Contact Name)*
Address Line 1*
Address Line 2
Town/City*
County*
Postcode*
Country*
Telephone*
Fax Number
Email Address*
Web Address
Account Number (if known)
* = compulsory fields
 
Invoice Address:
Company Name
Address Line 1
Address Line 2
Town/City
County
Country
Postcode
 
Products Ordered
Product Presentation Min order Price Quantity
Ostenil 20mg / 2ml syringe (single) 3 syringes £33.00
Ostenil Mini 10mg / 1ml syringe (single) 3 syringes £20.00
Viscoseal 10ml container (single) 3 units £49.50
Vismed 20mdu vials /0.3ml / 0.18% 66 packs £5.11
Vismed Multi 10ml bottle / 0.18% 10 bottles £6.81
Vismed Gel 20mdu vials / 0.45ml / 0.3% 10 packs £6.81
Vismed Light 15ml bottle / 0.1% 10 bottles £5.96
Laservis 5mdu / 2ml / 0.25% 5 packs £15.00
SUBTOTAL:
Postage: £8.00
TOTAL (ex. vat):
VAT (17.5%):
TOTAL (inc. vat):
Extra Information:



For Musculo-skeletal products minimum quantities apply at all times. If you wish to order less than the minimum quantity of ophthalmological products please contact Mid-Optic on 01332 295001 or email orders@mid-optic.com . If we receive your order before 12.00 noon we can usually deliver it on the following working day (UK only).

To view the terms and conditions, please click here, or we can send you a copy upon request. Please note that our prices are subject to change without prior notice.