Complete this form on your computer, then print it out and mail the completed form along with a U.S. Money Order or USA Check payable to MedIDs.com for ($24.00 ENGRAVING ON FRONT AND BACK SIDES) which includes all S&H charges for USPS Standard Delivery to the address below.

Emerg Alert Stainless Medical ID Necklace

Raised Red Medical Emblem on Front Tag size is 1-1/2" X 1/2"
Up to 5 lines of engraved text on back side.

  • Emergency Medical I.D. Wallet Card Included with order. $24.00  (INCLUDES S&H Charge)

    • Adult Medical Stainless Steel 30 inch Only Endless Necklace chain.
    The neckchain does not have a clasp.  Slips over head


      

    Back Side Option

    Text entered below is limited by the amount of available space on bracelet
    Note: Number in parentheses( ) indicates MAXIMUM # of letters & spaces per line


    Please DO NOT Highlite Text Below

    Back Side Line 1: (20)
    Back Side Line 2: (20)
    Back Side Line 3: (20)
    Back Side Line 4: (20)
    Back Side Line 5: (20)

    Recommendation: Include "SEE WALLET CARD" on the last line above.
    Keep a medical wallet card with current meds, medical conditions and emergency contacts in your wallet or purse.
    Medical information on the back remains private until needed.

    Mail To:
    First Name:
    Last Name:
    Address:
    City:
    State:
    Zip Code:
    Email Address:
    U.S. Money Order or USA Check payable to MedIDs.com for ($24.00 ENGRAVING ON FRONT AND BACK SIDES) which includes all S&H charges for USPS Standard Delivery to the address below.

    If the Print Button does not work on your computer, click on "FILE" - and choose "PRINT" on your browser.

    Mail Order / Fax - Payment Options Below!
    Mail a copy of this completed form with U.S. Money Order for $24.00 payable to "MedIDs.com" to:

    MedIDs.com/M.Stephens
    3103 Cypress St.
    Suite 3, PMB #159
    West Monroe, LA 71291-5270 USA
    Or FAX a copy of above order to:
    (866) 908-8843


    OR
    Pay by Credit Card
    Complete information below and we process payment when we receive this form.

    Pay using Credit Card:
    Credit Card Number:
    Expiration Date:CVV2 Security Code:What's This?


    Your mailing address where you receive your monthly card billing statement, if different from the above mailing address.

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