This page allows you to type your order at your computer, print the form, and fax it to Monarch Labs. Other versions of this form will allow you to phone, fax, or e-mail your order. You can select the form that's right for you, at: www.MonarchLabs.com/orders.htm

1. Enter the necessary information on your screen, using your computer keyboard.

2. Then PRINT a copy of this order page, sign it, date it, and fax it to: 949-679-3001.

3. We will call you to confirm receipt of your order. If you do not receive a confirmation call, then please call us (949-679-3000) to ensure that we received your order, and to ensure that it will arrive when you expect it.

4. Question? Problems? Call Monarch Labs at: 949-679-3000; or e-mail: sales@MonarchLabs.com.

To order electronically, don't use this form. Instead, use the MS Word, keyboard entry order form, and e-mail that form as an attachment to: sales@MonarchLabs.com. You can even save a copy of that completed order form on your own computer for reference, or save a partially completed version for use next time, so that you do not have to complete the entire order form.

Quantity Desired:	Item / Description	Cost Each
None 1 2 3 4 5 6	Medical Maggots (TM) - (Disinfected blow fly larvae; species=Phaenicia sericata). Each vial contains 250-500 larvae.	$98.00
None 1 2 3 4 5 6	Medical Maggots (TM) - (Disinfected blow fly larvae; species=Phaenicia sericata). Each vial contains 500-1,000 larvae.	$150.00
None 1 2 3 4 5 6 7 8 9 10 11 12	Creature Comforts (TM) - 4" x 4" Sterile polyester netted dressings	$ 7.50
None 1 2 3 4 5 6 7 8 9 10 11 12	Creature Comforts (TM) - 8" x 8" Sterile polyester netted dressings	$15.50
None 1 2 3 4 5 6 7 8 9 10 11 12	Creature Comforts (TM) - 12" x 12" Sterile polyester netted dressings	$ 21.50
None 1 2 3 4 5 6 7 8 9 10 11 12	Creature Comforts (TM) - 24" x 24" Sterile polyester netted dressings	$56.00
None 1 2 3 4 5 6 7 8 9 10 11 12	Creature Comforts (TM) - Sterile nylon stocking dressings	$12.00
None 1 2 3 4 5 6 7 8 9 10 11 12	Creature Comforts (TM) - Sterile nylon pantyhose dressings	$16.00
None 1 2 3 4 5 6 7 8 9 10 11 12	LeFlap (TM) 3" x 3" - Pre-assembled sterile polyester net wound dressings mounted to a hydrocolloid base, specifically designed for maggot therapy. For wounds < 2" diameter.	$16.50
None 1 2 3 4 5 6 7 8 9 10 11 12	LeFlap (TM) 6" x 6" - Pre-assembled sterile polyester net wound dressings mounted to a hydrocolloid base, specifically designed for maggot therapy. For wounds < 5" diameter.	$24.00
None 1 2 3 4 5 6 7 8 9 10 11 12	LeFlap DuJour (TM) 4" x 4" - Pre-assembled sterile polyester net wound dressings mounted to a hydrocolloid base, which can be cut to custom shapes and sizes. For wounds < 3" diameter.	$19.50
None 1 2 3 4 5 6 7 8 9 10 11 12	LeFlap DuJour (TM) 8" x 8" - Pre-assembled sterile polyester net wound dressings mounted to a hydrocolloid base, which can be cut to custom shapes and sizes. For wounds < 7" diameter.	$26.50
None 1 2 3 4 5 6 7 8 9 10 11 12	Hydrocolloid Pad, 4" x 4" - Used to make custom MDT dressings at the bedside. Simply cut a hole in the pad to match the wound, place remaining pad as a foundation around the wound, place the maggots on the wound bed within, and glue your porous cover (i.e., Creature Comforts polyester net) to the hydrocolloid foundation.	$9.75
None 1 2 3 4 5 6 7 8 9 10 11 12	Hydrocolloid Pad, 8" x 8" - Used to make custom MDT dressings at the bedside. Simply cut a hole in the pad to match the wound, place remaining pad as a foundation around the wound, place the maggots on the wound bed within, and glue your porous cover (i.e., Creature Comforts polyester net) to the hydrocolloid foundation.	$19.75
None 1 2 3 4 5 6 7 8 9 10 11 12	Nu-Hope Adhesive (TM) 1 oz - Used to glue the porous net (i.e., Creature Comforts) to the hydrocolloid pad. This liquid adhesive is coated onto the hydrocolloid and net dressings (brush included). No latex. Contains flammable solvents. Additional tape may be necessary.	$12.50
None 1 2 3 4 5 6 7 8 9 10 11 12	Tape, Durapore (TM) - 1? wide x 10 yards	$ 2.75
None 1 2 3 4 5 6 7 8 9 10 11 12	Transparent membrane dressing, 2? x 3? - each	$0.85
None 1 2 3 4 5 6 7 8 9 10 11 12	Transparent membrane dressing, 2? x 3? - box of 100	$69.00
None 1 2 3 4 5 6 7 8 9 10 11 12	Skin protectant wipe - various brands - 1 wipe, each	$0.50
None 1 2 3 4 5 6 7 8 9 10 11 12	Skin protectant wipe - various brands - Box of 50	$22.00
Other: 1 2 3 4 5 6 7 8 9 10 11 12	Specify:	To Be Determined

Medicinal Maggots are shipped Monday - Thursday via overnight delivery service, to arrive Tuesday - Friday.
Maggots can usually be shipped out within 24 hours.
Shipping charges include climate-controlled packaging, when required. Please specify:

Arrival Date desired:

Special Instructions (only 5 lines will print, so please be brief):

Shipping Information:

Billing information:

Signature of person placing the order: __________________________________ Date: ___________

Fine Print: All customers agree to the following: Maggots are provided only for patient care; this is not a license to breed or redistribute them in any way. The ordering clinician assumes full responsibility for patient care. No promise of safety or efficacy is implied, nor should it be inferred. Read and follow all packaging materials. Package inserts can be read or printed from here. Maggots are prepared upon order; they are highly perishable and can not be stored, reused, or returned. Problems with product quality must be reported within 24 hours of receipt to be eligible to receive refund or replacement (refund policy posted on internet). A fee may be assessed for orders cancelled less than 24 hours before shipping. Full refund policy is posted on this site. Prices subject to change without notice.