ABO Pharmaceuticals : Merck Customer Order Form

ABO Pharmaceuticals is proud to be your Authorized Distributor for
Merck Vaccines.

Note: This page is dedicated to Merck customers only. If your Merck representative did not direct you to this page, please click here to use our standard pre-book form.

	Merck Online Form
Please complete the form below to reserve your flu vaccine. A got flu? team member will contact you shortly to confirm your order.

Facility Name:

Contact Name:

Industry Type:

Address:

City:

State:

Zip:

Telephone:

Fax:

Email:

Confirm Email:

How did you hear about us?

Merck Representative's Name:

Total doses used for entire season?

Please check the brand/manufacture you prefer:

Afluria (Merck/CSL)

Will you be vaccinating children under 4 years of age?

Yes

Quantity of vials requested:
(10 doses per vial)

vial(s)

Quantity of syringes requested:
(10 syringes per box)

box(s)

	Call Us! A got flu? team member is standing by to assist you at 877-226-2266 or 949-699-2727

	Download PDF Form Download, complete and fax back to 949-457-0891

We Accept Credit Cards!