Imprinted Cap Request Form

Custom Imprinted Cap Request Form

Do you want your own custom imprint that seperates your pharmacy from the competition? Tri State Distribution is now offerring custom imprinted caps to be ordered online! Simply fill out the form below with your store information and design request. You will then receive a composite of your personalized imprinted cap within two business days. A 10 case minimum order is required to receive custom imprints. Allow up to 2-3 weeks for order and imprints to be completed. Feel free to look at some samples of designs we have done in the past by clicking here.

Customer Number

Pharmacy Name

Contact Name

Position

Phone Number

Fax Number

Email Address

Preferred Response

Please choose which cap type(s) you would like custom imprints for

Pro One™ Cap

Pro Plus™ Cap

Questions/Artwork Information

Once you fill out this form and click submit, it will send it to the appropriate person based on your selections. Once we receive your request, we will contact you ASAP. Thanks for your interest in our Imprinted Cap Program .

Enter the security code exactly as it appears:

Email: webmaster@provial.com
Phone: (800) 392-9824
Fax: (888) 946-7273