Order by Fax

352-331-6155

Order By Phone

352-331-3555

Order by Mail
Scrubs by Design
7054 NW 10th Place
Gainesville, Florida 32605


Home Phone: __________________________ email : ___________________________

Bill To:

Name: _________________________________________________________________________

Street: _________________________________________________________________________

City: ______________________________________________ State: _________Zip:___________

Item #

Description

Style

Size

Color

Qty

Unit Price

Total Price

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total Purchase

$

Domestic Shipping

$ 5.95

Sales Tax (6.25% Florida Residents)

$

Total Order

$

Method of Payment

VISA____ Master Card_____ Discover_____ American Express_____ Money Order_____

Card Number:

 

 

 

 

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Experation:

 

 

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Signature: ____________________________________________________Date: _________