Application for Credit — Card Authorization Form
Apply for credit from Medisafe Distribution Inc. today. Return the application for credit form to our office. We accept Visa, Mastercard, or American Express credit cards. Complete the form below and FAX it to our office at (604) 232-2445 — Thank you for visiting www.medisafecanada.com where you can benefit by purchasing less expensive, quality women’s health supplies like: Liberté copper IUDs, V-FreshPlus and V-Fresh active carbon inserts, FemCap, FemmyCycle, Dilapan-S and other useful gynecological ( OBGYN ) medical equipment and diagnostics.
The credit application form (carte de crédit formulaires d’autorisation) requests your details. Please download the PDF form below and fax it back to our office at: 604-232-2445