EmailMeForm
Galderma McKesson Email Order
Use this form to send email orders to McKesson. All fields are required.
McKesson Sold-To ID
*
McKesson Ship-To ID
*
Ship-To Name
*
First
Last
Ship-To Address
*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Payment Method
*
Please select
Terms
Credit Card
Last 4 Digits of Card On File (leave as-is if no card on file)
*
Product(s) Ordering
*
Dysport
Restylane-L 1ml
Restylane-L 0.5ml
Restylane 1ml (no Lido)
Restylane Lyft
Restylane Silk
Sculptra Aesthetic
Tri-Luma Cream
Number of Dysport Vials
*
Number of Restylane-L 1ml Syringes
*
Number of Restylane-L 0.5ml Syringes
*
Number of Restylane 1ml (no Lido) Syringes
*
Number of Restylane Lyft Syringes
*
Number of Restylane Silk Syringes
*
Number of Sculptra Aesthetic Kits
*
Number of Tri-Luma Cream tubes (multiples of 12)
*
Galderma Sales Professional Name
*
First
Last
Galderma Sales Professional Phone
*
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Galderma Sales Professional Email Address
*
