Ordering Information

Fax:
(314) 726-1028

Phone:
(800) 238-0870 OR
(314) 726-1060

Email:
sales@statband.com

We accept:
- Check
- MasterCard
- VISA
- American Express

LaserBand Remittance Address:
PO Box 957642
St. Louis, MO 63195-7642

For all other information:
120 S. Central Ave.
Suite 450
St. Louis, MO 63105

More Information

Ordering Information

CUSTOMER PROFILE - ORDERING INFORMATION

If you are a first time customer, please fill out our Customer Service Profile. To do so, complete the following form and click on the “Submit Customer Profile Information” button. Make sure you submit this form prior to emailing or faxing your first order to mailto:sales@laserband.com/(314)726-1028. Remember to include a copy of your W9 and a purchase order number. * Denotes required fields

Bill To

Ship To

Accounts Payable Contact

Company*

Address Line 1*

Address Line 2

Address Line 3

City*

State*

Zip*

Tax Identification #*

GPO Affiliation
Please complete if applicable.

Amerinet Broadlane HPG Premier MedAssets Novation
Member ID #
Tier Level Requested:
Requested by:

Preference for receipt of order acknowledgments:
Fax #: Email:

Company*

Address Line 1*

Address Line 2

Address Line 3

City*

State*

Zip*

Name*

Phone*

Fax*

E-mail*

Purchasing/Materials Contact

Name*

Phone*

Fax*

Email*

ORDERING INFORMATION:

TERMS AND PAYMENT INFORMATION:

Initial order must be placed via fax or email. To place subsequent orders or for ordering/invoicing/customer service questions:

Payment terms will be noted on all invoices.
LaserBand remittance address:

email	sales@statband.com
EDI	GHX
phone	800.238.0870 or 314.726.1060
fax	314.726.1028

Please provide a purchase order number (PO#) on all orders.
Minimum order is one full case.
100% order acknowledgement policy in effect. If you do not receive an acknowledgement within 1 business day after submission, please contact LaserBand immediately.

LaserBand
PO BOX 957642
St. Louis, MO 63195-7642

SHIPPING INFORMATION:

Standard freight charges will be prepaid and billed to customer if applicable.
Non-standard shipping requests, such as air or other expedited services, will be met and freight will be prepaid and billed to the customer.
UPS is used for package and freight shipments. If other carriers are requested, additional handling fees may apply.
Requests to ship same day must be received by noon CST.
Scheduled ship date will appear on order acknowledgement.

CUSTOMER SERVICE HOURS:
Monday - Friday 8:00am - 5:00pm (CST)
(except recognized holidays)

Submit Customer Profile Information

Color-Code	Adult	PED/Baby
Emergency/MCI	Extended Care	Laser Printed
Direct Thermal	Band W/Separate Label, Handwritten, Embossed

	Color-Code		Adult		PED/Baby
	Emergency/MCI		Laser Printed		Direct Thermal

	Color-Code		Adult		PED/Baby
	Patient Comfort

Color-Code	Adult	PED/Baby
Extended Care	Wristband Only	Wristband and Label Combo
Chart Labels Only

	Adult		Wristband Only		Color-Code
	PED/Baby

	Color-Code		Adult		PED/Baby
	Emergency / Triage / MCI

THE WORLD'S MOST ADVANCED EMERGENCY WRISTBANDS

CUSTOMER PROFILE - ORDERING INFORMATION