ØFastest ordering is our secure online order form at www.medlin.com.

ØIf you prefer to order by mail, print, then mail the completed order form.

E-Mail Address:        _______________________________________________

Name:                        _______________________________________________

Company:                  _______________________________________________

Address:                    _______________________________________________

City: _______________________    State: _______    Zip: ____________

Payment by:  Check ____  MC ____  Visa ____  Amex ____  Disc ____

Card Num.:______________________________________________________

Expiration Date:  ____________  (MM/YY)           Security Code: ___________

Phone Number:  _________________________  Fax: __________________

Card Holder's Signature:     _________________________________________