Clinic Order Form
Place Your Order
Select products, enter quantities, and submit. Volume pricing is applied automatically. A confirmation will be sent to your clinic email.
Minimum order: 10 units per line item
For help: [email protected]
Clinic information
Order — Finished Vials
Volume tiers:
5% off (25–49)
10% off (50–99)
15% off (100+)
| Product | Price per unit by tier | Qty | Line total |
|---|
Order — Injection pens
Volume tiers:
5% off (25–49)
10% off (50–99)
15% off (100+)
| Product | Price per unit by tier | Qty | Line total |
|---|
Order — Powder Vials
Volume tiers:
5% off (25–49)
10% off (50–99)
15% off (100+)
| Product | Price per unit by tier | Qty | Line total |
|---|
Subtotal (list price)$0.00
Volume discount—
Shipping$50.00
Est. order total$0.00
Special instructions
Authorized signature *
By typing your name above, you confirm that you are an authorized representative of the clinic named in this order, that all information provided is accurate, and that you agree to APG Life Sciences' payment terms per your existing account agreement. This submission does not constitute a binding order until confirmed in writing by APG Life Sciences.
Once your order has been submitted, it will be reviewed and verified by our team. You will receive an invoice for payment at the email address entered above. Orders are typically confirmed within 1–2 business days.
All prices in USD. Prices subject to change without notice. Orders are processed upon receipt and written confirmation. Payment terms per existing account agreement. This form does not constitute a binding order until confirmed in writing by APG Life Sciences.