TPNassist© order form

Institutions may use this web form to submit an order to RxKinetics. However, if you are an individual wanting to order our software, we require pre-payment.

Please do not use this form for credit card orders or payments.

Please do not use this form for academic orders.

Contact information

Institution name:
Your name:
Your Email address:

Area Code: Phone:
Your telephone:

Ordered by and pharmacy contact are the same
Pharmacy contact person:
Pharmacy contact Email:

Billing address

Bill to Address:

City:
State:
Zip code:

Shipping address


Please note: we cannot ship to Postal boxes

Bill to and Ship to addresses are the same
Ship to Address:

City:
State:
Zip code:

Order information

Choose one Cost

TPNassist© for Windows single license
For installation on one PC only 		$250.00

TPNassist© for Windows site (network) license
The site license permits unlimited installs at one business address.
Contact RxKinetics for multi-site pricing. 		$650.00

TPNassist© for Windows Personal use license
For installation on one PC only 		$125.00

Shipping & handling $ 10.00

Total

This program will be shipped on a CD-ROM.

Payment information

Institutional purchase order number (required for order):

PLEASE DO NOT USE THIS FORM FOR CREDIT CARD PAYMENT

OR

PLEASE DO NOT USE THIS FORM FOR CREDIT CARD PAYMENT

Click here for credit card orders

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RxKinetics, Plattsburg, MO 64477