To get a free quote or an enrollment packet simply 
copy this page and mail to the following:

____Before I enroll, please send me a written quote on the medications listed below.

____I am now ready to enroll. I have enclosed my check for $25 ( for a short time the yearly enrollment fee is only $15) per person made out to Medical Discounts International. Please send me the information necessary to begin purchasing medications from Canada. I understand that I will receive in return mail information on the program, order forms and pricing information. I will need to sign the forms  and return them along with an order form and a valid prescription from my doctor. To order immediately, I can fax the forms, order form and prescriptions. However, originals must be put in the mail soon thereafter.

International Medication Information Form
Name:
Mailing Address:
City, State, Zip:
Telephone:
Date:
Please provide the following for each medication
Name of Medication		Dosage/Quantity Desired
1.
2.
3.
4.
5.
Comments: