Equipment Order Form

To place an order please complete and submit the following form

 

Equipment Info    
     
Make & Model  
If other please specify  
Number of Units  
     
     
Study Info    
     
Sponsor  
Study Nr (internal / on invoice)  
Site Nr  
Hire / Purchase  
     
     
Delivery Info    
     
Hospital / Institute  
Department  
Address  
Postal Code  
City  
Country  
Telephone  
Fax  
Contact Name  
Email Address  
     
     
Ordering party info    
     
Company Name  
Ordered by (name)  
Email Address  
Invoice Details  
PO Number  
Requested Shipment Date  
Remarks  
     
   
     
 

If you are ready to order, please follow these steps:

Step One

Please fill in our Order form and submit

Step Two

An order confirmation will be sent from MESM

If you need any help, please do not hesitate to contact us:

MESM
Logistics House,
Buckshaw Avenue,
Chorley,
Lancashire,
PR6 7AJ


T: +44 (0) 1257 225776
F: +44 (0) 1257 225539
Email: sales@mesm.co.uk