Veterans Distribution Network, LLC
Veterans Distribution Network, LLC

Customer Preliminary Quote Form

Please fill out the form below to receive a discounted price quote from VDN on medical, dental or hospital equipment and supplies. Our minimum order is $50.00 and restocking fees may apply on returned items. If required, product substitutions will be offered for your approval. Remember to note on the form whether it is being used for obtaining a preliminary quote or to purchase items now.
 

COMPANY INFORMATION:
Company/Agency Name:
 Department & Title:
Contact Person:
 Tax Exempt?
 Yes  No
Office Phone:
 Fax Number:
Email Address:
 Cell Phone:
Address:
City:
 State:
 Zip:
Existing customers please provide a VDN account #:
Quote or Purchase Order #:
 Purchasing items Now?
Yes  No		 VDN Reps Name:
 GSA Contract #:
 
ITEMS TO BE QUOTED:
Manufacturers Name Mfg Item# Qty UOM Description

Thank You For Your Business!
Additional information including Desired Delivery Date and/or Ship to address:
VETERANS DISTRIBUTION NETWORK, LLC
A   L I M I T E D   L I A B I L I T Y   C O M P A N Y
5425 North 59th Street
Tampa, Florida 33610
Phone: (800) 448-9630/ Fax: (813) 707-0228

Home Page | Products | Quote Form | About Us | Contact Us

Copyright © 2008 Veterans Distribution Network and its licensors. All rights reserved.
Trademarks not owned by VDN are owned by other companies. Rights to design elements such as
photos and graphics remain the property of their respective owners.