Q2 Clinic Merchandise

Order your quarterly merchandising package by Jan. 21, 2019.

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2019 Seasonal Merchandising Order Form

Please fill out the form below for each individual clinic. Clinics have the option to not order elements listed below.

Clinic Contact Name: *

Clinic Name: *

Complete Clinic Address: *

Address Line 1

Address Line 2

City

State

Zip Code

Clinic Contact Phone Number: *

Email *

Merchandise Selection

How Many Exam Rooms in This Clinic? *

EXAM ROOM POSTERS (11x17) : Select 1 Version *

PO1
PO2
PO3
PO4

DANGLERS (11x17) : Select 1, Qty = 2 per Clinic *

DO1
DO2
DO3
DO4

FRONT DESK DISPLAY (8.5x11) : Select 1, Qty = 1 *

FDO1
FDO2
FDO3
FDO4

SANDWICH BOARD POSTER (24x36) : Limit 1 set of 2 *

SBO1
SBO2
SBO3
SBO4

Do you need a Front Desk Acrylic Stand? *

Yes
No

Do you need a Sandwich Board Display? *

Yes
No

Total

$ 0.00

Comment

Questions?

Contact Melanie Laird

Your success is important to us and we have dedicated our best for you. Have questions about Always On or Merchandising please reach out.

Email

melanie@reflexblu.com

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Office Hours

Monday-Friday:
8am – 5pm

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Phone

(205) 403-3122

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Location

429 Emery Dr.
Birmingham, AL 35244