Glucojel POS Order Form

Pharmacy Name

Contact Name

Pharmacy address

State

Postcode

Phone

Order

Product:

GC061 Glucojel Counter Unit

GC061 Quantity (Max. 10)

Product:

GC043 Glucojel Dump Bin

GC043 Quantity (Max. 10)

Product:

GC068 Glucojel Floor Stand

GC068 Quantity (Max. 10)

Product:

GC056 Glucojel Sweet Memories Clip Strip

GC056 Quantity (Max. 10)

Product:

GC063 Glucojel Vegan-Friendly Clip Strips

GC063 Quantity (Max. 10)

Select a choice