Prescription Verifier Order Form
Name
Company
Address
City
 
State
Zip
Country
Email
Phone
Fax
Rx Software
Vendor
Vendor Phone
Vendor Fax
Can you lookup drug in computer software by entering NDC# ?    Yes    No    Not Sure
Computer Operating System?   
Computer Brand
Computer Type
Keyboard Brand
Terminal Brand/Model
Size of 1st keyboard computer cable plug?    *
Size of 2nd keyboard computer cable plug?    *
* Other types of keyboards or terminals may require special cables and/or power supply at an extra cost.


RxScan Plus Kit
Service Contract 1 Year
(Software License & Updates, Technical Support)
Battery
Communication cable
Stand
Shipping & Handling
 
Tax
 

Yes, I would like to receive relevant information from RxScan via e-mail in the future.
RxScan® - Designs for Quick Installation and Effortless Use
© 1998 - 2007. U.S. Patent Numbers 6,098,892 and 6,260,761 & patents pending.