Mylan Enterprises - Order Form

We have a True Business ID Server Certificate with GeoTrust and there should be no concern on your part to utilize this order form. If you have any difficulties filling in the form, please email us at techhelp@weewee.mylanusa.com You also have the option of calling us at 1- 800-852-8119.

Please fill in the form below to send us your order.

*Which publication, search engine or referral did you use to find us?*
*Email address:*
*Your Name:*
If Business Address Please Insert Company Name:
*Address:*
*Address:*
*Apt/Suite #:*
*City:*
*State:*		*Zip:*
*Telephone Number:*
*Any other pertinent information you wish to add to this order?*

Item #	*Qty*	Unit Price	Qty Times Price




*UPS Charges West Miss*
*Florida Residents Add 6.5% Sales Tax*
*Order Total*

Payment Method

Check: Click Here for remittance address.
Order will be shipped upon receipt of payment!

Credit Card: Fill in the information below!

Questions? Simply E-mail us or call us at 1-800-852-8119

Please use this form for faxing, mailing or submitting your secure order to us. Thank you!

Card Type:	(MasterCard, Visa, Discover, American Express)
Card No:
Enter CVV (Credit Card Validation/Verification-fraud prevention tool) 3-digit number found on back of card on the magnetic strip for Visa/Mastercard/Discover and 4 digit non-embossed number found on front of card for American Express.
Expiration Date (mm/yr):
Name Appearing on Card: