Printable Order Form
At VitalityMedical.com, we supply to hospitals, nursing homes, government agencies, sports teams, and physician offices throughout the United States. To place purchase orders, please fill out a credit application listed below. Once you have filled out the credit application, please fax it back to us at the fax number found on the application.
Note: An order form must be filled out and submitted with the credit application for the order to be processed. Additionally, if you are a first time customer interested in placing purchase orders, it takes approximately two weeks for credit approval.
In addition to professional use, order forms may also be used by private customers. If you prefer to mail in a check or money order, you may fill out an order form and mail it to us with your check to place an order.
Order Forms Vitality Medical Order Form
New Customer Request Form is for Net 30 customers and regular customers that would like us to attach a purchase order number to the order.