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Dispensing Doctor Orders
  

Dispensing Doctor Order Form for GLUSARTEL and MANEVAC
Please select the required product from the below PRODUCT NAME menu. After completing the order details please click the SUBMIT button. Your order will be sent directly to our pre-wholesaler MOVIANTO for despatch. If this is the first time you are using this you will be contacted by MOVIANTO and set up as a Dispensing Doctor customer. This direct ordering service is only available for Dispensing Doctors.

*indicates required fields 
  *Delivery Address:
  *Post Code:
  Invoice Address (if differs from Delivery Address):
  Postcode:
  *Contact Name:
  *Contact Telephone No:
  *Contact Email address:
  *Product Name:
  *Product Manufacturer:
  *Pack Size:
  *Quantity:
  *Product Code:
  *Dispensing Price:
  *Security Code: Type Loading... in the textbox below.

After completing your order details please click on the SUBMIT button to send your order to MOVIANTO.
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