Use this on-line form to place an order using a purchase order (PO). If you are placing an order using a credit card (US and Canada only), please call ALZET Customer Service at 877-922-5938, or download and fill out the ALZET fax order form.

If ordering from outside of the US or Canada, please download our international ordering instructions, or contact customer service for further information.

Once you submit your order, a customer service representative will contact you within one business day to confirm your order and pricing information.

**We are currently experiencing higher than normal call volumes.  If you do not reach us immediately, please leave a message and we will return your call.**

Request Prices

Products

Billing Information

Order Placed By

Shipping Information

Available domestic shipping options are FedEx ground, second day, or overnight. If one of these options is not selected at the time of ordering, we will ship via FedEx ground. For specific shipping costs, please contact us.

ALZET Customer Service will contact you by the next business day to confirm your order and to supply pricing information. You may wish to print this form before submitting your order so you have a copy for your records.