Purchase Order Form

Please complete all sections of this Peptides Purchase Order Form accurately. Ensure all information is correct and authorized prior to submission. Incorrect information may result in delays or order rejection.

Company Information

Company Name^*

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Contact Name^*

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Street Address^*

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State^*

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City^*

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Zip Code^*

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Phone^*

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Email^*

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NPI/Medical License^*

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DEA License (If Applicable)

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EIN

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Medical State License

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Shipping Address

Street Address^*

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State^*

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City^*

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Zip Code^*

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Purchase Order

Peptides Products

Select All

Healing & Recovery

BPC-157 (10mg) Tissue, gut, joint repair

$28

BPC-157 (10mg) + TB-500 (10mg) Accelerated healing & inflammation control

$43

Growth Hormone & Recovery

CJC-1295 No DAC (5mg) + Ipamorelin (5mg)

CJC-1295 No DAC (5mg) + Ipamorelin (5mg) GH optimization & recovery

$33

Sermorelin (10mg) Sleep, recovery, GH signaling

$38

Tesamorelin (10mg) Visceral fat & metabolic health

$45

Tesamorelin (10mg) + Ipamorelin (5mg) Enhanced GH & metabolic support

$67

Metabolism & Weight Management

GLP-1 R (24mg)

$67

GLP-1 S (20mg)

$47

GLP-1 T (60mg) Weight Loss Blend

$157

GLP-1 T (75mg)

$194

Hormone & Cellular Energy Support

HCG (5000 IU) Testicular & hormonal support

$29

NAD+ Biofermented (1000mg / 5mL vial) Cellular energy & mitochondrial support

$57

Purchase Order Total

Terms: Payment is due immediately upon recipt of the invoice

Preview

Company Information

Company Name : ABC Company

Contact Name : John Davis

Street Address : 1254, Street 3

State : Texas

City : Houston

Zip Code : 11111

Phone : 111-111-1111

Email : john.davis@abccompany.com

NPI / Medical License : -

DEA License (If Applicable) : -

EIN : -

Medical State License : -

Shipping Address

Street Address : 1254, Street 3

State : Texas

City : Houston

Zip Code : 11111

Purchase Order

Healing & Recovery

PRICE

QUANTITY

Total

Purchase Order Total

$736

Terms: Payment is due immediately upon recipt of the invoice

Vendor

Rescience 3028 Greenmount Avenue Unit 2012 Baltimore, MD 21218-3938 resciencetrust@outlook.com

COMMENTS OR SPECIAL INSTRUCTIONS Cold storage, fragile goods to be shipped. BUD 90 days from the time of fill.

Purchase Order Authorization

I confirm that I am duly authorized to submit and approve this purchase order on behalf of the company and that all information provided is accurate and complete.

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PLACE ORDER

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