Qosmedix: Source Request

HOME

PRICE LIST

SIGN-UP FOR QOSMEDIX
eNEWSLETTER

HELPFUL
CONVERSION CHARTS

Lloyd's Register Quality Assurance ISO9001 / Underwriters Laboratories ISO 14001 Certification

Looking for customization? No problem! Fill out this form to give us a description of what you are looking for, and we’ll do the research for you, at no charge. Using our extensive library of resource materials, catalogs, and samples, we can save you time and effort as well as expense.

Just send us a sample and your specifications.

Please note, if you decide to purchase a custom item, 50% payment in advance is required. Custom items are non-refundable unless our QA Department determines a manufacturing defect and authorizes the return of the parts.

* Required

Salutation:
First Name:	^*
Last Name:	^*
Company:	^*
Employer #: (Tax ID #, or Sales ID #)
This is an optional field, however, should you decide to place an order with Qosmedix, a tax ID number is required for US customers.
Address:	^*
2nd line:
City:	^*
State/Province:	^*
Zip/Postal Code:	^*
Country:	^*
Phone Number:	^*
Fax Number:	^*
E-mail Address:	^*
Company Website:
Requests or Comments:

*** Please click the submit button 1 (one) time only.
It takes a few seconds to process your request.
Thank You.

150-Q Executive Drive, Edgewood, New York 11717-8329 U.S.A.
PHONE: (631) 242-3270 • FAX: (631) 242-242-3230 • E-Mail: info@qosmedix.com