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PELLET ORDER FORM
ALL ORDERS MUST BE SHIPPED TO ADDRESS AS LISTED ON CURRENT DEA LICENSE.
ESTRADIOL
ESTRADIOL 6 MG | BOX 6
1 / Box 6 / 6 mg
2 / Box 6 / 6 mg
3 / Box 6 / 6 mg
4 / Box 6 / 6 mg
5 / Box 6 / 6 mg
6 / Box 6 / 6 mg
7 / Box 6 / 6 mg
8 / Box 6 / 6 mg
9 / Box 6 / 6 mg
10 / Box 6 / 6 mg
None
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ESTRADIOL 10 MG | BOX 6
1 / Box 6 / 10 mg
2 / Box 6 / 10 mg
3 / Box 6 / 10 mg
4 / Box 6 / 10 mg
5 / Box 6 / 10 mg
6 / Box 6 / 10 mg
7 / Box 6 / 10 mg
8 / Box 6 / 10 mg
9 / Box 6 / 10 mg
10 / Box 6 / 10 mg
None
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ESTRADIOL 6 MG | BOX 12
1 / Box 12 / 6 mg
2 / Box 12 / 6 mg
3 / Box 12 / 6 mg
4 / Box 12 / 6 mg
5 / Box 12 / 6 mg
6 / Box 12 / 6 mg
7 / Box 12 / 6 mg
8 / Box 12 / 6 mg
9 / Box 12 / 6 mg
10 / Box 12 / 6 mg
None
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ESTRADIOL 6 MG | BOX 30
1 / Box 30 / 6 mg
2 / Box 30 / 6 mg
3 / Box 30 / 6 mg
4 / Box 30 / 6 mg
5 / Box 30 / 6 mg
6 / Box 30 / 6 mg
7 / Box 30 / 6 mg
8 / Box 30 / 6 mg
9 / Box 30 / 6 mg
10 / Box 30 / 6 mg
None
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ESTRADIOL 10 MG | BOX 12
1 / Box 12 / 10 mg
2 / Box 12 / 10 mg
3 / Box 12 / 10 mg
4 / Box 12 / 10 mg
5 / Box 12 / 10 mg
6 / Box 12 / 10 mg
7 / Box 12 / 10 mg
8 / Box 12 / 10 mg
9 / Box 12 / 10 mg
10 / Box 12 / 10 mg
None
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ESTRADIOL 10 MG | BOX 30
1 / Box 30 / 10 mg
2 / Box 30 / 10 mg
3 / Box 30 / 10 mg
4 / Box 30 / 10 mg
5 / Box 30 / 10 mg
6 / Box 30 / 10 mg
7 / Box 30 / 10 mg
8 / Box 30 / 10 mg
9 / Box 30 / 10 mg
10 / Box 30 / 10 mg
None
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ESTRADIOL 12.5 MG | BOX 6
1 / Box 6 / 12.5 mg
2 / Box 6 / 12.5 mg
3 / Box 6 / 12.5 mg
4 / Box 6 / 12.5 mg
5 / Box 6 / 12.5 mg
6 / Box 6 / 12.5 mg
7 / Box 6 / 12.5 mg
8 / Box 6 / 12.5 mg
9 / Box 6 / 12.5 mg
10 / Box 6 / 12.5 mg
None
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ESTRADIOL 12.5 MG | BOX 12
1 / Box 12 / 12.5 mg
2 / Box 12 / 12.5 mg
3 / Box 12 / 12.5 mg
4 / Box 12 / 12.5 mg
5 / Box 12 / 12.5 mg
6 / Box 12 / 12.5 mg
7 / Box 12 / 12.5 mg
8 / Box 12 / 12.5 mg
9 / Box 12 / 12.5 mg
10 / Box 12 / 12.5 mg
None
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ESTRADIOL 12.5 MG | BOX 30
1 / Box 30 / 12.5 mg
2 / Box 30 / 12.5 mg
3 / Box 30 / 12.5 mg
4 / Box 30 / 12.5 mg
5 / Box 30 / 12.5 mg
6 / Box 30 / 12.5 mg
7 / Box 30 / 12.5 mg
8 / Box 30 / 12.5 mg
9 / Box 30 / 12.5 mg
10 / Box 30 / 12.5 mg
None
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ESTRADIOL 15 MG | BOX 6
1 / Box 6 / 15 mg
2 / Box 6 / 15 mg
3 / Box 6 / 15 mg
4 / Box 6 / 15 mg
5 / Box 6 / 15 mg
6 / Box 6 / 15 mg
7 / Box 6 / 15 mg
8 / Box 6 / 15 mg
9 / Box 6 / 15 mg
10 / Box 6 / 15 mg
None
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ESTRADIOL 18 MG | BOX 6
1 / Box 6 / 18 mg
2 / Box 6 / 18 mg
3 / Box 6 / 18 mg
4 / Box 6 / 18 mg
5 / Box 6 / 18 mg
6 / Box 6 / 18 mg
7 / Box 6 / 18 mg
8 / Box 6 / 18 mg
9 / Box 6 / 18 mg
10 / Box 6 / 18 mg
None
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ESTRADIOL 15 MG | BOX 12
1 / Box 12 / 15 mg
2 / Box 12 / 15 mg
3 / Box 12 /15 mg
4 / Box 12 / 15 mg
5 / Box 12 / 15 mg
6 / Box 12 / 15 mg
7 / Box 12 / 15 mg
8 / Box 12 / 15 mg
9 / Box 12 / 15 mg
10 / Box 12 / 15 mg
None
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ESTRADIOL 15 MG | BOX 30
1 / Box 30 / 15 mg
2 / Box 30 / 15 mg
3 / Box 30 / 15 mg
4 / Box 30 / 15 mg
5 / Box 30 / 15 mg
6 / Box 30 / 15 mg
7 / Box 30 / 15 mg
8 / Box 30 / 15 mg
9 / Box 30 / 15 mg
10 / Box 30 / 15 mg
None
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ESTRADIOL 18 MG | BOX 12
1 / Box 12 / 18 mg
2 / Box 12 / 18 mg
3 / Box 12 / 18 mg
4 / Box 12 / 18 mg
5 / Box 12 / 18 mg
6 / Box 12 / 18 mg
7 / Box 12 / 18 mg
8 / Box 12 / 18 mg
9 / Box 12 / 18 mg
10 / Box 12 / 18 mg
None
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ESTRADIOL 18 MG | BOX 30
1 / Box 30 / 18 mg
2 / Box 30 / 18 mg
3 / Box 30 / 18 mg
4 / Box 30 / 18 mg
5 / Box 30 / 18 mg
6 / Box 30 / 18 mg
7 / Box 30 / 18 mg
8 / Box 30 / 18 mg
9 / Box 30 / 18 mg
10 / Box 30 / 18 mg
None
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ESTRADIOL 20 MG | BOX 6
1 / Box 6 / 20 mg
2 / Box 6 / 20 mg
3 / Box 6 / 20 mg
4 / Box 6 / 20 mg
5 / Box 6 / 20 mg
6 / Box 6 / 20 mg
7 / Box 6 / 20 mg
8 / Box 6 / 20 mg
9 / Box 6 / 20 mg
10 / Box 6 / 20 mg
None
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ESTRADIOL 22 MG | BOX 6
1 / Box 6 / 22 mg
2 / Box 6 / 22 mg
3 / Box 6 / 22 mg
4 / Box 6 / 22 mg
5 / Box 6 / 22 mg
6 / Box 6 / 22 mg
7 / Box 6 / 22 mg
8 / Box 6 / 22 mg
9 / Box 6 / 22 mg
10 / Box 6 / 22 mg
None
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ESTRADIOL 25 MG | BOX 6
1 / Box 6 / 25 mg
2 / Box 6 / 25 mg
3 / Box 6 / 25 mg
4 / Box 6 / 25 mg
5 / Box 6 / 25 mg
6 / Box 6 / 25 mg
7 / Box 6 / 25 mg
8 / Box 6 / 25 mg
9 / Box 6 / 25 mg
10 / Box 6 / 25 mg
None
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ESTRADIOL 20 MG | BOX 12
1 / Box 12 / 20 mg
2 / Box 12 / 20 mg
3 / Box 12 / 20 mg
4 / Box 12 / 20 mg
5 / Box 12 / 20 mg
6 / Box 12 / 20 mg
7 / Box 12 / 20 mg
8 / Box 12 / 20 mg
9 / Box 12 / 20 mg
10 / Box 12 / 20 mg
None
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ESTRADIOL 20 MG | BOX 30
1 / Box 30 / 20 mg
2 / Box 30 / 20 mg
3 / Box 30 / 20 mg
4 / Box 30 / 20 mg
5 / Box 30 / 20 mg
6 / Box 30 / 20 mg
7 / Box 30 / 20 mg
8 / Box 30 / 20 mg
9 / Box 30 / 20 mg
10 / Box 30 / 20 mg
None
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ESTRADIOL 22 MG | BOX 12
1 / Box 12 / 22 mg
2 / Box 12 / 22 mg
3 / Box 12 / 22 mg
4 / Box 12 / 22 mg
5 / Box 12 / 22 mg
6 / Box 12 / 22 mg
7 / Box 12 / 22 mg
8 / Box 12 / 22 mg
9 / Box 12 / 22 mg
10 / Box 12 / 22 mg
None
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ESTRADIOL 22 MG | BOX 30
1 / Box 30 / 22 mg
2 / Box 30 / 22 mg
3 / Box 30 / 22 mg
4 / Box 30 / 22 mg
5 / Box 30 / 22 mg
6 / Box 30 / 22 mg
7 / Box 30 / 22 mg
8 / Box 30 / 22 mg
9 / Box 30 / 22 mg
10 / Box 30 / 22 mg
None
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ESTRADIOL 25 MG | BOX 12
1 / Box 12 / 25 mg
2 / Box 12 / 25 mg
3 / Box 12 / 25 mg
4 / Box 12 / 25 mg
5 / Box 12 / 25 mg
6 / Box 12 / 25 mg
7 / Box 12 / 25 mg
8 / Box 12 / 25 mg
9 / Box 12 / 25 mg
10 / Box 12 / 25 mg
None
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ESTRADIOL 25 MG | BOX 30
1 / Box 30 / 25 mg
2 / Box 30 / 25 mg
3 / Box 30 / 25 mg
4 / Box 30 / 25 mg
5 / Box 30 / 25 mg
6 / Box 30 / 25 mg
7 / Box 30 / 25 mg
8 / Box 30 / 25 mg
9 / Box 30 / 25 mg
10 / Box 30 / 25 mg
None
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TESTOSTERONE
TESTOSTERONE 12.5 MG | BOX 6
1 / Box 6 / 12.5 mg
2 / Box 6 / 12.5 mg
3 / Box 6 / 12.5 mg
4 / Box 6 / 12.5 mg
5 / Box 6 / 12.5 mg
6 / Box 6 / 12.5 mg
7 / Box 6 / 12.5 mg
8 / Box 6 / 12.5 mg
9 / Box 6 / 12.5 mg
10 / Box 6 / 12.5 mg
None
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TESTOSTERONE 12.5 MG | BOX 12
1 / Box 12 / 12.5 mg
2 / Box 12 / 12.5 mg
3 / Box 12 / 12.5 mg
4 / Box 12 / 12.5 mg
5 / Box 12 / 12.5 mg
6 / Box 12 / 12.5 mg
7 / Box 12 / 12.5 mg
8 / Box 12 / 12.5 mg
9 / Box 12 / 12.5 mg
10 / Box 12 / 12.5 mg
None
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TESTOSTERONE 12.5 MG | BOX 30
1 / Box 30 / 12.5 mg
2 / Box 30 / 12.5 mg
3 / Box 30 / 12.5 mg
4 / Box 30 / 12.5 mg
5 / Box 30 / 12.5 mg
6 / Box 30 / 12.5 mg
7 / Box 30 / 12.5 mg
8 / Box 30 / 12.5 mg
9 / Box 30 / 12.5 mg
10 / Box 30 / 12.5 mg
None
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TESTOSTERONE 25 MG | BOX 6
1 / Box 6 / 25 mg
2 / Box 6 / 25 mg
3 / Box 6 / 25 mg
4 / Box 6 / 25 mg
5 / Box 6 / 25 mg
6 / Box 6 / 25 mg
7 / Box 6 / 25 mg
8 / Box 6 / 25 mg
9 / Box 6 / 25 mg
10 / Box 6 / 25 mg
None
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TESTOSTERONE 25 MG | BOX 12
1 / Box 12 / 25 mg
2 / Box 12 / 25 mg
3 / Box 12 / 25 mg
4 / Box 12 / 25 mg
5 / Box 12 / 25 mg
6 / Box 12 / 25 mg
7 / Box 12 / 25 mg
8 / Box 12 / 25 mg
9 / Box 12 / 25 mg
10 / Box 12 / 25 mg
None
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TESTOSTERONE 25 MG | BOX 30
1 / Box 30 / 25 mg
2 / Box 30 / 25 mg
3 / Box 30 / 25 mg
4 / Box 30 / 25 mg
5 / Box 30 / 25 mg
6 / Box 30 / 25 mg
7 / Box 30 / 25 mg
8 / Box 30 / 25 mg
9 / Box 30 / 25 mg
10 / Box 30 / 25 mg
None
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TESTOSTERONE 37.5 MG | BOX 6
1 / Box 6 / 37.5 mg
2 / Box 6 / 37.5 mg
3 / Box 6 / 37.5 mg
4 / Box 6 / 37.5 mg
5 / Box 6 / 37.5 mg
6 / Box 6 / 37.5 mg
7 / Box 6 / 37.5 mg
8 / Box 6 / 37.5 mg
9 / Box 6 / 37.5 mg
10 / Box 6 / 37.5 mg
None
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TESTOSTERONE 37.5 MG | BOX 12
1 / Box 12 / 37.5 mg
2 / Box 12 / 37.5 mg
3 / Box 12 / 37.5 mg
4 / Box 12 / 37.5 mg
5 / Box 12 / 37.5 mg
6 / Box 12 / 37.5 mg
7 / Box 12 / 37.5 mg
8 / Box 12 / 37.5 mg
9 / Box 12 / 37.5 mg
10 / Box 12 / 37.5 mg
None
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TESTOSTERONE 37.5 MG | BOX 30
1 / Box 30 / 37.5 mg
2 / Box 30 / 37.5 mg
3 / Box 30 / 37.5 mg
4 / Box 30 / 37.5 mg
5 / Box 30 / 37.5 mg
6 / Box 30 / 37.5 mg
7 / Box 30 / 37.5 mg
8 / Box 30 / 37.5 mg
9 / Box 30 / 37.5 mg
10 / Box 30 / 37.5 mg
None
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TESTOSTERONE 50 MG | BOX 6
1 / Box 6 / 50 mg
2 / Box 6 / 50 mg
3 / Box 6 / 50 mg
4 / Box 6 / 50 mg
5 / Box 6 / 50 mg
6 / Box 6 / 50 mg
7 / Box 6 / 50 mg
8 / Box 6 / 50 mg
9 / Box 6 / 50 mg
10 / Box 6 / 50 mg
None
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TESTOSTERONE 50 MG | BOX 12
1 / Box 12 / 50 mg
2 / Box 12 / 50 mg
3 / Box 12 / 50 mg
4 / Box 12 / 50 mg
5 / Box 12 / 50 mg
6 / Box 12 / 50 mg
7 / Box 12 / 50 mg
8 / Box 12 / 50 mg
9 / Box 12 / 50 mg
10 / Box 12 / 50 mg
None
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TESTOSTERONE 50 MG | BOX 30
1 / Box 30 / 50 mg
2 / Box 30 / 50 mg
3 / Box 30 / 50 mg
4 / Box 30 / 50 mg
5 / Box 30 / 50 mg
6 / Box 30 / 50 mg
7 / Box 30 / 50 mg
8 / Box 30 / 50 mg
9 / Box 30 / 50 mg
10 / Box 30 / 50 mg
None
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TESTOSTERONE 87.5 MG | BOX 6
1 / Box 6 / 87.5 mg
2 / Box 6 / 87.5 mg
3 / Box 6 / 87.5 mg
4 / Box 6 / 87.5 mg
5 / Box 6 / 87.5 mg
6 / Box 6 / 87.5 mg
7 / Box 6 / 87.5 mg
8 / Box 6 / 87.5 mg
9 / Box 6 / 87.5 mg
10 / Box 6 / 87.5 mg
None
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TESTOSTERONE 87.5 MG | BOX 12
1 / Box 12 / 87.5 mg
2 / Box 12 / 87.5 mg
3 / Box 12 / 87.5 mg
4 / Box 12 / 87.5 mg
5 / Box 12 / 87.5 mg
6 / Box 12 / 87.5 mg
7 / Box 12 / 87.5 mg
8 / Box 12 / 87.5 mg
9 / Box 12 / 87.5 mg
10 / Box 12 / 87.5 mg
None
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TESTOSTERONE 87.5 MG | BOX 30
1 / Box 30 / 87.5 mg
2 / Box 30 / 87.5 mg
3 / Box 30 / 87.5 mg
4 / Box 30 / 87.5 mg
5 / Box 30 / 87.5 mg
6 / Box 30 / 87.5 mg
7 / Box 30 / 87.5 mg
8 / Box 30 / 87.5 mg
9 / Box 30 / 87.5 mg
10 / Box 30 / 87.5 mg
None
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TESTOSTERONE 100 MG | BOX 6
1 / Box 6 / 100 mg
2 / Box 6 / 100 mg
3 / Box 6 / 100 mg
4 / Box 6 / 100 mg
5 / Box 6 / 100 mg
6 / Box 6 / 100 mg
7 / Box 6 / 100 mg
8 / Box 6 / 100 mg
9 / Box 6 / 100 mg
10 / Box 6 / 100 mg
None
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TESTOSTERONE 100 MG | BOX 12
1 / Box 12 / 100 mg
2 / Box 12 / 100 mg
3 / Box 12 / 100 mg
4 / Box 12 / 100 mg
5 / Box 12 / 100 mg
6 / Box 12 / 100 mg
7 / Box 12 / 100 mg
8 / Box 12 / 100 mg
9 / Box 12 / 100 mg
10 / Box 12 / 100 mg
None
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TESTOSTERONE 100 MG | BOX 30
1 / Box 30 / 100 mg
2 / Box 30 / 100 mg
3 / Box 30 / 100 mg
4 / Box 30 / 100 mg
5 / Box 30 / 100 mg
6 / Box 30 / 100 mg
7 / Box 30 / 100 mg
8 / Box 30 / 100 mg
9 / Box 30 / 100 mg
10 / Box 30 / 100 mg
None
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TESTOSTERONE 200 MG | BOX 6
1 / Box 6 / 200 mg
2 / Box 6 / 200 mg
3 / Box 6 / 200 mg
4 / Box 6 / 200 mg
5 / Box 6 / 200 mg
6 / Box 6 / 200 mg
7 / Box 6 / 200 mg
8 / Box 6 / 200 mg
9 / Box 6 / 200 mg
10 / Box 6 / 200 mg
None
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TESTOSTERONE 200 MG | BOX 12
1 / Box 12 / 200 mg
2 / Box 12 / 200 mg
3 / Box 12 / 200 mg
4 / Box 12 / 200 mg
5 / Box 12 / 200 mg
6 / Box 12 / 200 mg
7 / Box 12 / 200 mg
8 / Box 12 / 200 mg
9 / Box 12 / 200 mg
10 / Box 12 / 200 mg
None
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TESTOSTERONE 200 MG | BOX 30
1 / Box 30 / 200 mg
2 / Box 30 / 200 mg
3 / Box 30 / 200 mg
4 / Box 30 / 200 mg
5 / Box 30 / 200 mg
6 / Box 30 / 200 mg
7 / Box 30 / 200 mg
8 / Box 30 / 200 mg
9 / Box 30 / 200 mg
10 / Box 30 / 200 mg
None
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TESTOSTERONE/ANASTRAZOLE COMBO PELLET
COMBO PELLET 200/20 MG | BOX 6
1 / Box 6 / 200/20 mg
2 / Box 6 / 200/20 mg
3 / Box 6 / 200/20 mg
4 / Box 6 / 200/20 mg
5 / Box 6 / 200/20 mg
6 / Box 6 / 200/20 mg
7 / Box 6 / 200/20 mg
8 / Box 6 / 200/20 mg
9 / Box 6 / 200/20 mg
10 / Box 6 / 200/20 mg
None
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COMBO PELLET 200/20 MG | BOX 12
1 / Box 12 / 200/20 mg
2 / Box 12 / 200/20 mg
3 / Box 12 / 200/20 mg
4 / Box 12 / 200/20 mg
5 / Box 12 / 200/20 mg
6 / Box 12 / 200/20 mg
7 / Box 12 / 200/20 mg
8 / Box 12 / 200/20 mg
9 / Box 12 / 200/20 mg
10 / Box 12 / 200/20 mg
None
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COMBO PELLET 200/20 MG | BOX 30
1 / Box 30 / 200/20 mg
2 / Box 30 / 200/20 mg
3 / Box 30 / 200/20 mg
4 / Box 30 / 200/20 mg
5 / Box 30 / 200/20 mg
6 / Box 30 / 200/20 mg
7 / Box 30 / 200/20 mg
8 / Box 30 / 200/20 mg
9 / Box 30 / 200/20 mg
10 / Box 30 / 200/20 mg
None
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DISPOSABLE TROCAR KITS
REUSABLE TROCAR KITS
PLEASE NOTE: THE TURN AROUND TIME ON REUSABLE TROCAR SETS CAN BE LONGER THAN THE DISPOSABLE KITS
ALL ORDERS RECEIVED AFTER 3 P.M. CST WILL BE PROCESSED THE FOLLOWING BUSINESS DAY.
SHIPPING INFORMATION (check one):
OVERNIGHT (most expensive)
2-DAY EXPRESS (medium price)
REGULAR GROUND (lowest price)
QUALGEN WILL PAY REGULAR GROUND ON ALL ORDERS OVER $2,000.
SUBMIT
