Biomox Pharmaceuticals - Production Request

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Production Request

REQUEST FOR PRODUCTION (PURCHASE ORDER)

Online Request Form (Purchase Order)
Company Information
Order Date:
Company name:	*
Contact person:	*
Telephone No:	*
Fax No:
E-Mail:

Product Information
Name of product:	*
Tablets, Capsules or Sachets?:	*
Colour and size capsule / Tablet size and shape / Sachet size:	*
Quantity Caps / Tabs ordered / Sachets :	*
Container size:	*
Colour of lid:	*
Pack size e.g. 30’s, 60’s, bulk, etc.:	*
Labels / Top stickers:	*
Cartons / Booklets:	*
Package inserts / Leaflets:	*
* Required Fields