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Catalog Request Form

Our 2010 Buying Guide is currently available.

Domestic Customers - If you would like one mailed to your office, please supply the necessary information below. Please allow 2-4 weeks for delivery.

International Customers - Because of unreliable mail service and minimum mail quantity requirements, Delasco will no longer mail printed copies of our 2010 Dermatologic Buying Guide to international locations. If you would still like a printed copy of our catalog, we would happily include one in your next order shipment.

Note: Our website is the best place to find current pricing and product information.

Printable Order Form
In order to open the downloaded printable order form, you will need Adobe Reader. To download Adobe Reader, simply click on the Get Adobe Reader icon.

Required fields are marked in bold.


Physician's Name:
Institution or Practice Name:
Medical Specialty:
License Number:
Address:
City:
State/Province:
Country:
ZIP / Postal Code:
Phone Number:
Person Requesting:
Email Address:

Address Information:: This is my only mailing address.; This is an additional mailing address.