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Request for Quote - On/Go™ 10-minute COVID-19 Antigen Self-Test
Blue Wave Medical, LLC
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Email
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Buyer / Company Name
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Contact Person - Enter First & Last Name
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Bill-To-Address - Please enter complete address.
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Contact Person Phone Number
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Please enter quantity of test box (2 pk) to be quoted.
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Need-by Date. Please enter as MM-DD-YY
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Do you anticipate there will be repeat/recurring orders? (Yes-Frequency, Maybe-Undecided, No)
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Shipping Preference - please indicate one. A) Buyer to provide own shipping & Bill of Lading. B) Shipper to coordinate & add shipping fees to order separately. C) Other - Please explain.
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Ship-To-Contact Name & Address. Please enter complete shipping address.
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Ship-To-Contact Email Address & Phone Number
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Required Documents - To be provided at time of Order. Please indicate which will apply. A) Sales Tax Exemption Certificate B) IRS Form W-9 (Buyer & End-buyer) C) Wholesaler Certificate (if applicable)
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Authorized Buyer Name & Title
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Thank you! Please provide any comments or preferences for this inquiry.
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