Get Fill Out Each Section Of The Order Form Completely And Mail In The Envelope Provided

Filling out the order form correctly is essential to ensure your over-the-counter essentials are delivered promptly. This guide provides comprehensive steps to assist you in completing the form accurately and efficiently.

Follow the steps to complete your order form online

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering your Member ID number as specified on the front of your health insurance card. This information is crucial for verifying your eligibility.
3. Next, provide your Member Name in the designated field. Ensure that this matches the name associated with your health insurance account.
4. Fill in your Shipping Address. Include Shipping Address 1, and if applicable, use the Shipping Address 2 field for any additional address details, such as apartment number or facility name.
5. Complete the City, State, and ZIP Code fields with the relevant information. Accuracy in these sections helps ensure timely delivery.
6. If there is a Responsible Party for the order, provide that person's information in the respective field. If not applicable, you may leave it blank.
7. Enter the Daytime Phone of the Member or Responsible Party to allow for any necessary communication regarding the order.
8. In the item section, list the Item #, Size, Color, and Product Description for each product you wish to order. Make sure to refer to the catalog if available.
9. Specify the Quantity for each item you are ordering. Ensure that the total order value meets the minimum amount of $30 in Benefit Credits.
10. Review the Prices for each item and calculate the TOTAL for your order, including any other applicable charges like shipping, handling, and taxes.
11. After completing the form, save changes, and choose to download, print, or share the form as necessary before mailing it.
12. Finally, place the completed order form in the envelope provided, or use your own envelope with correct postage. Mail it to FirstLine Medical at P.O. Box 268630, Weston, FL 33326-9866.

Complete your document and submit your order form online today for a smooth experience.