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.

Customize Bracelet below:
Make a Options selection at each arrow ( )

Make your TEXT and EMBLEM Engraving Selection below.

You have the option of adding Red enamel color to the TEXT and EMBLEM
Indicate below: Make selection in Drop Down Here

Please read information on the engraved Text and Emblem below.>
The engraved Text and Emblem are permanently engraved into the stainless id tag,and will never wear off in normal use, however the ADDED RED ENAMEL color is affected by wear and is NOT PERMANENT. The clear engraving makes your confidential information less obvious from casual view until the information is needed, yet this information is easily read when needed by emergency personnel. There is no additional charge to add the red enamel color however may require one (1) additional day to engrave and ship.

Available without the Medical Emblem if desired
Make selection below

The standard length 27.0 inch stainless necklace chain is included with your pendant.
However a 24" or a 18" snap steel beaded chain is available.
Make the neckchain selection below.

Make Selection Here

Front Side

To reduce chances of order errors please use computer keyboard and TYPE engraving information below!

Enter Front Text below if you want to include information on the front side of bracelet.

Please DO NOT Highlite Text Below
Front Side Line 1: (12)
Front Side Line 2: (12)
Front Side Line 3: (14)
Front Side Line 4: (14)

Recommendation: Add the words "OVER" or "SEE BACK SIDE" to line 4 above
to insure the engraving text on the back side is not over looked in case of emergency.

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: (12)
Back Side Line 2: (12)
Back Side Line 3: (14)
Back Side Line 4: (14)
Back Side Line 5: (14)
Back Side Line 6: (14)

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.

All custom engraved products are non-refundable as stated in our return policy.

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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