Forms

Bound Tree Medical would like to make the purchasing process as simple as possible. To help ensure fast, dependable service, a number of forms have been created in PDF format for you to download. You may fax completed forms to 800.257.5713. If you have any questions or need assistance completing any of the forms, please contact Customer Service or your Account Manager.

  • Order Form – Submit an order.
  • Federal Government Application – Federal government agencies may purchase on open account, pending application.
  • State & Municipal Application – State government agencies and municipalities may purchase on open account, pending application.
  • Credit Application – If you are not a federal or state government agency or municipality, you may apply for open account status by completing a Credit Application.
  • License Authorization Form (LAF) – Submit Medical Director and/or Pharmacist-in-Charge authorization for approval to purchase prescription drugs, controlled substances and/or medical devices.
  • Controlled Substance Ordering Guidelines – Bound Tree Medical requires a License Authorization Form (LAF), current license/certificate and a Federal DEA 222 Form to process controlled substance orders. Please follow these instructions for completing the Federal DEA 222 Form.