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Vasacor Fax or Mail Order Form



Fill out this form online, then click the Print button to
print it to your computer. You can then fax it to us at;

(503) 295-7359 

All fields are required.

Order Date:
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Vasacor Orders Dept.
818 SW 3rd Ave • Suite #220
Portland, OR 97204-2405


Your order will be processed on the next business day after receipt.
Thank You for your order!
The Vasacor Staff •
www.vasacor.com

 

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