Handheld PC 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
RxScan Ultra Kit
Service Contract 1 Year
(Software License & Updates, Technical Support)
Protection Service
(Warranty upgrade to guarantee replacement of your
Symbol MC50 Pocket PC)
MC50 AC Power Adapter Cup for use with stand
(This item is required when using a stand) 
Additional Extended Battery
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.