Please enter on this form (OB5) the details that you want on the invoice and your details for reference.
PLEASE PROVIDE DETAILS RE THE PURCHASING ENTITY:
DETAILS TO GO ON THE INVOICE:
PLEASE PROVIDE DETAILS REGARDING THE CARE FACILITY THAT WILL BE USING REME:
LIST THE ITEMS TO BE PURCHASED AND PRICE AGREED FOR EACH - LINE BY LINE, AND DEFINE ANY DISCOUNTS PROVIDED:
PROVIDE THE TOTAL INVOICE COST AND THE VAT COMPONENT
On receipt of payment ReMe will be activated within 3 working days.
PLEASE PROVIDE DETAILS OF THE PERSON WHO INTRODUCED REME TO YOU (optional):