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<TITLE>RxUSA  Prescription Drugs, Medications, Discount Drugstore, Pharmacy</TITLE>
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<script language="JavaScript1.1">	

<!-- hide 

/// ##### MUST add onchange="saveValue(this)" ######################

var never = new Date()

// never.setTime(never.getTime() + 2000*24*60*60*1000);

never.setTime(never.getTime() + 2000*24*60*60*1000);



// name is a string of the name of your cookie

// value is the value corresponding to name

function SetCookie(name, value) {

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use_cookies = "";



function saveValue(element) {

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   //+"to be stored on YOUR Computer so that they will be pre-filled next "

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}

function setstoredValuesCookieYesNo() {
if(document.FrontPage_Form2.use_cookies){val=document.FrontPage_Form2.use_cookies.selectedIndex;}
if (val == '0' || val == 'no' ){
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	//   SetCookie("memory_"+ "FrontPage_Form2"+"_"+ "use_cookies", "",expString);
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function getstoredValuesCookieYesNo() {
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}

function storedValues() {

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    cookie_name = "memory_"+document.forms[i].name+"_"

     +document.forms[i].elements[j].name;

    val = GetCookie(cookie_name);

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     || (document.forms[i].elements[j].type == "password")

     || (document.forms[i].elements[j].type == "textarea")) {

      document.forms[i].elements[j].value = val;


     } else if (document.forms[i].elements[j].type.indexOf("select") != -1) {

      document.forms[i].elements[j].selectedIndex = -1;



      while (((pos = val.indexOf(" ")) != -1) && (val.length > 1)) {

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        document.forms[i].elements[j].options[sel].selected = true;

      }

     } else if (document.forms[i].elements[j].type == "checkbox") {

      document.forms[i].elements[j].checked = val;

     } else if (document.forms[i].elements[j].type == "radio") {

      if (document.forms[i].elements[j].value == val)

       document.forms[i].elements[j].checked = true;

     }

    }

   }

  }

 }

}

// /////////////////////////////////////////////////
function DeleteValues() {

 if (document.images ) { // only do it in JavaScript 1.1 browsers

  for (i=0;i<document.forms.length;i++) {

   for (j=0;j<document.forms[i].elements.length; j++) {

    cookie_name = "memory_"+document.forms[i].name+"_"

     +document.forms[i].elements[j].name;

    val = GetCookie(cookie_name);

    if (val) {

     if ((document.forms[i].elements[j].type == "text")

     || (document.forms[i].elements[j].type == "password")

     || (document.forms[i].elements[j].type == "textarea")) {

// my stuff below // ----------------------
document.forms[i].elements[j].value= "";
document.forms[i].elements[j].value= val;

 SetCookie("memory_"+document.forms[i].name+"_"

     +document.forms[i].elements[j].name , "");

// end my stuff // ----------------

     } else if (document.forms[i].elements[j].type.indexOf("select") != -1) {

      document.forms[i].elements[j].selectedIndex = -1;

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        document.forms[i].elements[j].options[sel].selected = true;

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     } else if (document.forms[i].elements[j].type == "checkbox") {

      document.forms[i].elements[j].checked = val;

     } else if (document.forms[i].elements[j].type == "radio") {

      if (document.forms[i].elements[j].value == val)

       document.forms[i].elements[j].checked = true;

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}
// /-------------------------------------------------------------------------------
function check_user(){

 if(document.FrontPage_Form2){

//	if ( document.FrontPage_Form2.first_name.value == ""  &&  document.FrontPage_Form2.last_name.value == "" &&  document.FrontPage_Form2.email.value == ""  || document.FrontPage_Form2.use_cookies.selectedIndex == "1"){storedValues();}
	if ( document.FrontPage_Form2){if( document.FrontPage_Form2.use_cookies.selectedIndex == "1"){storedValues();}}

	}

}

// End -->
</script>

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/*  THIS IS THE TABLE COLOR SCRIPT - Include CODE in the <TABLE> TAG
Highlight Table Cells Script- 
*/
function changeto(highlightcolor){

source=event.srcElement

if (source.tagName=="TR"||source.tagName=="TABLE")

return

while(source.tagName!="TD")

source=source.parentElement

if (source.style.backgroundColor!=highlightcolor&&source.id!="ignore")

source.style.backgroundColor=highlightcolor

}

function changeback(originalcolor){

if (event.fromElement.contains(event.toElement)||source.contains(event.toElement)||source.id=="ignore")

return

if (event.toElement!=source)

source.style.backgroundColor=originalcolor

}

function vis(cur,which){

if (which==0)

cur.filters.alpha.opacity=60

else

cur.filters.alpha.opacity=100

}
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<SCRIPT LANUAGE="Javascript">
function searchbox(){
if(document.search2.name2.value=="Enter Drug Name"){document.search2.name2.value='';}
}
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}
//-->
</script>
<script LANGUAGE="JavaScript1.2">

function format(nums)

   {

/////////////////////////////////////////////////////////////////////////
// rounds total to two decimal places

nums = "" + ((Math.round(nums * 100)) / 100);

dec1 = nums.substring(nums.length-3, nums.length-2);

dec2 = nums.substring(nums.length-2, nums.length-1);

if (dec1 != '.') { // adds trailing zeroes if necessary

if (dec2 == '.') nums += "0";

else nums += ".00";

}
return nums;
/////////////////////////////////////////////////////////////////////////
}
function calcit(){

for (i = 0 ; i < document.forms.length ; i++)  

if(document.forms[i].qty && document.forms[i].price){ 

	// calc the base price //
	document.forms[i].price.value=format((document.forms[i].cprice.value * document.forms[i].qty.options[document.forms[i].qty.selectedIndex].value));

	// calc the base price AND give a discount for ordering more//
if(document.forms[i].qty.options[document.forms[i].qty.selectedIndex].value=='2' || document.forms[i].qty.options[document.forms[i].qty.selectedIndex].value =='60'){

	document.forms[i].price.value=format((document.forms[i].price.value * 0.99));

  }else if(document.forms[i].qty.options[document.forms[i].qty.selectedIndex].value=='3' || document.forms[i].qty.options[document.forms[i].qty.selectedIndex].value =='90'){

	document.forms[i].price.value=format((document.forms[i].price.value * 0.985));

 }else if(document.forms[i].qty.options[document.forms[i].qty.selectedIndex].value=='4' || document.forms[i].qty.options[document.forms[i].qty.selectedIndex].value > 90){

	document.forms[i].price.value=format((document.forms[i].price.value * 0.9825));

  }
// calc the price per pill or per unit //
if(document.forms[i].qty.options[document.forms[i].qty.selectedIndex].value > '0'){
document.forms[i].perpill.value="Unit cost $" + format(document.forms[i].price.value / document.forms[i].qty.options[document.forms[i].qty.selectedIndex].value ) + " " + "each";
}
}
}
//end calcit
</script>
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function FrontPage_Form2_Validator(theForm)
{

  if (theForm.First_Name.value == "")
  {
    alert("Please enter a value for the \"First Name\" field.");
    theForm.First_Name.focus();
    return (false);
  }

  if (theForm.First_Name.value.length < 2)
  {
    alert("Please enter at least 2 characters in the \"First Name\" field.");
    theForm.First_Name.focus();
    return (false);
  }

  if (theForm.First_Name.value.length > 200)
  {
    alert("Please enter at most 200 characters in the \"First Name\" field.");
    theForm.First_Name.focus();
    return (false);
  }

  var checkOK = "ABCDEFGHIJKLMNOPQRSTUVWXYZabcdefghijklmnopqrstuvwxyzƒŠŒŽšœžŸÀÁÂÃÄÅÆÇÈÉÊËÌÍÎÏÐÑÒÓÔÕÖØÙÚÛÜÝÞßàáâãäåæçèéêëìíîïðñòóôõöøùúûüýþÿ";
  var checkStr = theForm.First_Name.value;
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  var validGroups = true;
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  {
    ch = checkStr.charAt(i);
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      if (ch == checkOK.charAt(j))
        break;
    if (j == checkOK.length)
    {
      allValid = false;
      break;
    }
  }
  if (!allValid)
  {
    alert("Please enter only letter characters in the \"First Name\" field.");
    theForm.First_Name.focus();
    return (false);
  }

  if (theForm.Last_Name.value == "")
  {
    alert("Please enter a value for the \"Last Name\" field.");
    theForm.Last_Name.focus();
    return (false);
  }

  if (theForm.Last_Name.value.length < 2)
  {
    alert("Please enter at least 2 characters in the \"Last Name\" field.");
    theForm.Last_Name.focus();
    return (false);
  }

  if (theForm.Last_Name.value.length > 300)
  {
    alert("Please enter at most 300 characters in the \"Last Name\" field.");
    theForm.Last_Name.focus();
    return (false);
  }

  var checkOK = "ABCDEFGHIJKLMNOPQRSTUVWXYZabcdefghijklmnopqrstuvwxyzƒŠŒŽšœžŸÀÁÂÃÄÅÆÇÈÉÊËÌÍÎÏÐÑÒÓÔÕÖØÙÚÛÜÝÞßàáâãäåæçèéêëìíîïðñòóôõöøùúûüýþÿ";
  var checkStr = theForm.Last_Name.value;
  var allValid = true;
  var validGroups = true;
  for (i = 0;  i < checkStr.length;  i++)
  {
    ch = checkStr.charAt(i);
    for (j = 0;  j < checkOK.length;  j++)
      if (ch == checkOK.charAt(j))
        break;
    if (j == checkOK.length)
    {
      allValid = false;
      break;
    }
  }
  if (!allValid)
  {
    alert("Please enter only letter characters in the \"Last Name\" field.");
    theForm.Last_Name.focus();
    return (false);
  }

  if (theForm.areacode.value == "")
  {
    alert("Please enter a value for the \"Area Code\" field.");
    theForm.areacode.focus();
    return (false);
  }

  if (theForm.areacode.value.length < 2)
  {
    alert("Please enter at least 2 characters in the \"Area Code\" field.");
    theForm.areacode.focus();
    return (false);
  }

  if (theForm.areacode.value.length > 3)
  {
    alert("Please enter at most 3 characters in the \"Area Code\" field.");
    theForm.areacode.focus();
    return (false);
  }

  var checkOK = "0123456789-- \t\r\n\f";
  var checkStr = theForm.areacode.value;
  var allValid = true;
  var validGroups = true;
  for (i = 0;  i < checkStr.length;  i++)
  {
    ch = checkStr.charAt(i);
    for (j = 0;  j < checkOK.length;  j++)
      if (ch == checkOK.charAt(j))
        break;
    if (j == checkOK.length)
    {
      allValid = false;
      break;
    }
  }
  if (!allValid)
  {
    alert("Please enter only digit, whitespace and \"-\" characters in the \"Area Code\" field.");
    theForm.areacode.focus();
    return (false);
  }

  if (theForm.prefix.value == "")
  {
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    return (false);
  }

  if (theForm.prefix.value.length < 1)
  {
    alert("Please enter at least 1 characters in the \"Phone Prefix\" field.");
    theForm.prefix.focus();
    return (false);
  }

  if (theForm.prefix.value.length > 4)
  {
    alert("Please enter at most 4 characters in the \"Phone Prefix\" field.");
    theForm.prefix.focus();
    return (false);
  }

  if (theForm.extension.value == "")
  {
    alert("Please enter a value for the \"Phone Last 4 Digits\" field.");
    theForm.extension.focus();
    return (false);
  }

  if (theForm.extension.value.length < 4)
  {
    alert("Please enter at least 4 characters in the \"Phone Last 4 Digits\" field.");
    theForm.extension.focus();
    return (false);
  }

  if (theForm.extension.value.length > 7)
  {
    alert("Please enter at most 7 characters in the \"Phone Last 4 Digits\" field.");
    theForm.extension.focus();
    return (false);
  }

  if (theForm.email.value == "")
  {
    alert("Please enter a value for the \"Email\" field.");
    theForm.email.focus();
    return (false);
  }

  if (theForm.email.value.length < 5)
  {
    alert("Please enter at least 5 characters in the \"Email\" field.");
    theForm.email.focus();
    return (false);
  }

  if (theForm.email.value.length > 400)
  {
    alert("Please enter at most 400 characters in the \"Email\" field.");
    theForm.email.focus();
    return (false);
  }

  var checkOK = "ABCDEFGHIJKLMNOPQRSTUVWXYZabcdefghijklmnopqrstuvwxyzƒŠŒŽšœžŸÀÁÂÃÄÅÆÇÈÉÊËÌÍÎÏÐÑÒÓÔÕÖØÙÚÛÜÝÞßàáâãäåæçèéêëìíîïðñòóôõöøùúûüýþÿ0123456789-@._-";
  var checkStr = theForm.email.value;
  var allValid = true;
  var validGroups = true;
  for (i = 0;  i < checkStr.length;  i++)
  {
    ch = checkStr.charAt(i);
    for (j = 0;  j < checkOK.length;  j++)
      if (ch == checkOK.charAt(j))
        break;
    if (j == checkOK.length)
    {
      allValid = false;
      break;
    }
  }
  if (!allValid)
  {
    alert("Please enter only letter, digit and \"@._-\" characters in the \"Email\" field.");
    theForm.email.focus();
    return (false);
  }

  if (theForm.drug1.value == "")
  {
    alert("Please enter a value for the \"Drug Name\" field.");
    theForm.drug1.focus();
    return (false);
  }

  if (theForm.drug1.value.length < 2)
  {
    alert("Please enter at least 2 characters in the \"Drug Name\" field.");
    theForm.drug1.focus();
    return (false);
  }

  if (theForm.drug1.value.length > 39)
  {
    alert("Please enter at most 39 characters in the \"Drug Name\" field.");
    theForm.drug1.focus();
    return (false);
  }

  var checkOK = "ABCDEFGHIJKLMNOPQRSTUVWXYZabcdefghijklmnopqrstuvwxyzƒŠŒŽšœžŸÀÁÂÃÄÅÆÇÈÉÊËÌÍÎÏÐÑÒÓÔÕÖØÙÚÛÜÝÞßàáâãäåæçèéêëìíîïðñòóôõöøùúûüýþÿ0123456789-,\" \t\r\n\f";
  var checkStr = theForm.drug1.value;
  var allValid = true;
  var validGroups = true;
  for (i = 0;  i < checkStr.length;  i++)
  {
    ch = checkStr.charAt(i);
    for (j = 0;  j < checkOK.length;  j++)
      if (ch == checkOK.charAt(j))
        break;
    if (j == checkOK.length)
    {
      allValid = false;
      break;
    }
  }
  if (!allValid)
  {
    alert("Please enter only letter, digit, whitespace and \",\"\" characters in the \"Drug Name\" field.");
    theForm.drug1.focus();
    return (false);
  }

  if (theForm.Comments.value.length > 500)
  {
    alert("Please enter at most 500 characters in the \"Comments\" field.");
    theForm.Comments.focus();
    return (false);
  }

  if (theForm.human.value == "")
  {
    alert("Please enter a value for the \"Security\" field.");
    theForm.human.focus();
    return (false);
  }

  if (theForm.human.value.length < 4)
  {
    alert("Please enter at least 4 characters in the \"Security\" field.");
    theForm.human.focus();
    return (false);
  }

  if (theForm.human.value.length > 10)
  {
    alert("Please enter at most 10 characters in the \"Security\" field.");
    theForm.human.focus();
    return (false);
  }
  return (true);
}
//--></script><!--webbot BOT="GeneratedScript" endspan --><FORM METHOD="POST" ACTION="/cgi-bin2/webform_cust_human.cgi" onSubmit="return FrontPage_Form2_Validator(this)" language="JavaScript" name="FrontPage_Form2">
 
<INPUT TYPE="hidden" NAME="redirect" VALUE="http://rxusa.com/html_new/thankyou_shopping.htm">
<INPUT TYPE="hidden" NAME="subject" VALUE="RxUSA Quote Request">
<INPUT TYPE="hidden" NAME="required" VALUE="email,First_Name,Last_Name">
<INPUT TYPE="hidden" NAME="recipient" VALUE="orders">
<INPUT TYPE="hidden" NAME="recipient2" VALUE="rxusa.com">

            
            
<DIV ALIGN="center"><CENTER><TABLE BORDER="1" CELLPADDING="0" CELLSPACING="0" STYLE="border-collapse: collapse" BORDERCOLOR="#111111" WIDTH="98%">
    <TR>
          <TD WIDTH="100%" ALIGN="center">
          
                        
                <STRONG><FONT SIZE="4"><BR>
                Free <a name="Quote">Quote</a> Form<br>
                </FONT>
                </STRONG><span style="background-color: #7DBEFF">[</span><a href="#checkprice"><span style="background-color: #7DBEFF">Price check online now click here</span></a><span style="background-color: #7DBEFF">]</span><STRONG><FONT SIZE="4"><BR>
                </FONT>
                </STRONG><STRONG STYLE="font-weight: 400"><FONT SIZE="2">**FREE SHIPPING ON MOST ORDERS OVER $300.00**(Call for details)<BR>
                <BR>
                </FONT></STRONG><B>Patient Information:</B>
                
                           
                <TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" STYLE="border-collapse: collapse" BORDERCOLOR="#111111">
                    <TR>
                                                                 <td align="right" HEIGHT="22" STYLE="font-family: Times New Roman; font-size: 12pt">&nbsp; 
                                                                 <SELECT SIZE="1" NAME="use_cookies" onchange="setstoredValuesCookieYesNo(),saveValue(this),check_user()">
                                                                         <OPTION VALUE="no">No</OPTION>
                                                                         <OPTION VALUE="yes">Yes</OPTION>
                                                                 </SELECT></td>
                                                                 <td HEIGHT="22" STYLE="font-family: Times New Roman; font-size: 10pt">&nbsp;Save my below information for next time.</td>
                                                            </TR>
                    <TR>
                          <TD>First
                Name:</TD>
                          <TD><font size="3" color="#000066">
                           &nbsp;<!--WEBBOT BOT="Validation" S-DISPLAY-NAME="First Name" S-DATA-TYPE="String" B-ALLOW-LETTERS="TRUE" B-VALUE-REQUIRED="TRUE" I-MINIMUM-LENGTH="2" I-MAXIMUM-LENGTH="200" --><input onchange="saveValue(this)"  maxLength="200" size="25" name="First_Name"> </font></TD>
                    </TR>
                    <TR>
                          <TD>Last
                Name:</TD>
                          <TD><font size="3" color="#000066">
                           &nbsp;<!--WEBBOT BOT="Validation" S-DISPLAY-NAME="Last Name" S-DATA-TYPE="String" B-ALLOW-LETTERS="TRUE" B-VALUE-REQUIRED="TRUE" I-MINIMUM-LENGTH="2" I-MAXIMUM-LENGTH="300" --><input onchange="saveValue(this)"  maxLength="300" size="25" name="Last_Name"></font></TD>
                    </TR>
                    <TR>
                          <TD>Daytime Phone :</TD>
                          <TD>&nbsp;(<font size="3" color="#000066">
                           <!--WEBBOT BOT="Validation" S-DISPLAY-NAME="Area Code" S-DATA-TYPE="String" B-ALLOW-DIGITS="TRUE" B-ALLOW-WHITESPACE="TRUE" S-ALLOW-OTHER-CHARS="-" B-VALUE-REQUIRED="TRUE" I-MINIMUM-LENGTH="2" I-MAXIMUM-LENGTH="3" --><input onchange="saveValue(this)"  maxLength="3" size="4" name="areacode"></font>) <font size="3" color="#000066">
                           &nbsp;<!--WEBBOT BOT="Validation" S-DISPLAY-NAME="Phone Prefix" B-VALUE-REQUIRED="TRUE" I-MINIMUM-LENGTH="1" I-MAXIMUM-LENGTH="4" --><input onchange="saveValue(this)"  maxLength="4" size="4" name="prefix"></font>-<font size="3" color="#000066">
                           <!--WEBBOT BOT="Validation" S-DISPLAY-NAME="Phone Last 4 Digits" B-VALUE-REQUIRED="TRUE" I-MINIMUM-LENGTH="4" I-MAXIMUM-LENGTH="7" --><input onchange="saveValue(this)"  maxLength="7" size="5" name="extension"></font></TD>
                    </TR>
                    <TR>
                          <TD>
                Email
                Address:</TD>
                          <TD><font size="3" color="#000066">
                           &nbsp;
                           <!--WEBBOT BOT="Validation" S-DISPLAY-NAME="Email" S-DATA-TYPE="String" B-ALLOW-LETTERS="TRUE" B-ALLOW-DIGITS="TRUE" S-ALLOW-OTHER-CHARS="@._-" B-VALUE-REQUIRED="TRUE" I-MINIMUM-LENGTH="5" I-MAXIMUM-LENGTH="400" --><input onchange="saveValue(this)"  size="35" name="email" maxlength="400"></font></TD>
                    </TR>
                    </TABLE>
                <hr align="center">
                <P><B>Drug Quote(s) Requested:&nbsp;</B></P>
                <DIV ALIGN="center"><CENTER><TABLE BORDER="0" CELLPADDING="2" CELLSPACING="0" STYLE="border-collapse: collapse" BORDERCOLOR="#111111">
                    <TR>
                          <TD><font size="3">Drug Name:</font></TD>
                          <TD>&nbsp;</TD>
                          <TD ALIGN="center"><font size="3">&nbsp;Strength:</font></TD>
                          <TD>&nbsp;</TD>
                          <TD ALIGN="center"><font size="3">&nbsp;Quantity: </font></TD>
                    </TR>
                    <TR>
                          <TD><font size="3" color="#000066">
                			<!--WEBBOT BOT="Validation" S-DISPLAY-NAME="Drug Name" S-DATA-TYPE="String" B-ALLOW-LETTERS="TRUE" B-ALLOW-DIGITS="TRUE" B-ALLOW-WHITESPACE="TRUE" S-ALLOW-OTHER-CHARS=",&quot;" B-VALUE-REQUIRED="TRUE" I-MINIMUM-LENGTH="2" I-MAXIMUM-LENGTH="39" --><input size="30" name="drug1" maxlength="39"></font></TD>
                          <TD>&nbsp;</TD>
                          <TD ALIGN="center"><font size="3" color="#000066"><input size="8" name="strength1"></font></TD>
                          <TD>&nbsp;</TD>
                          <TD ALIGN="center"><font size="3" color="#000066"><input size="4" name="quan1"></font></TD>
                    </TR>
                    <TR>
                          <TD><font size="3" color="#000066">
                <input size="30" name="drug2"></font></TD>
                          <TD>&nbsp;</TD>
                          <TD ALIGN="center"><font size="3" color="#000066"><input size="8" name="strength2"></font></TD>
                          <TD>&nbsp;</TD>
                          <TD ALIGN="center"><font size="3" color="#000066"><input size="4" name="quan2"></font></TD>
                    </TR>
                    <TR>
                          <TD><font size="3" color="#000066">
                <input size="30" name="drug3"></font></TD>
                          <TD>&nbsp;</TD>
                          <TD ALIGN="center"><font size="3" color="#000066"><input size="8" name="strength3"></font></TD>
                          <TD>&nbsp;</TD>
                          <TD ALIGN="center"><font size="3" color="#000066"><input size="4" name="quan3"></font></TD>
                    </TR>
                    <TR>
                          <TD><font size="3" color="#000066">
                <input size="30" name="drug4"></font></TD>
                          <TD>&nbsp;</TD>
                          <TD ALIGN="center"><font size="3" color="#000066"><input size="8" name="strength4"></font></TD>
                          <TD>&nbsp;</TD>
                          <TD ALIGN="center"><font size="3" color="#000066"><input size="4" name="quan4"></font></TD>
                    </TR>
                    <TR>
                          <TD><font size="3" color="#000066">
                <input size="30" name="drug5"></font></TD>
                          <TD>&nbsp;</TD>
                          <TD ALIGN="center"><font size="3" color="#000066"><input size="8" name="strength5"></font></TD>
                          <TD>&nbsp;</TD>
                          <TD ALIGN="center"><font size="3" color="#000066"><input size="4" name="quan5"></font></TD>
                    </TR>
                    <TR>
                          <TD><font size="3" color="#000066">
                <input size="30" name="drug6"></font></TD>
                          <TD>&nbsp;</TD>
                          <TD ALIGN="center"><font size="3" color="#000066"><input size="8" name="strength6"></font></TD>
                          <TD>&nbsp;</TD>
                          <TD ALIGN="center"><font size="3" color="#000066"><input size="4" name="quan6"></font></TD>
                    </TR>
                </TABLE>
                </CENTER></DIV>
                <p>Comments:<BR>
                <!--WEBBOT BOT="Validation" S-DISPLAY-NAME="Comments" I-MAXIMUM-LENGTH="500" --><TEXTAREA ROWS="2" NAME="Comments" COLS="40"></TEXTAREA></p>
				<p>&nbsp;</p>
				<DIV ALIGN="center">
            <CENTER>
            <FONT COLOR="#000080"><B>
            Security:
            <!--WEBBOT BOT="Validation" S-DISPLAY-NAME="Security" B-VALUE-REQUIRED="TRUE" I-MINIMUM-LENGTH="4" I-MAXIMUM-LENGTH="10" --><input name="human" size="15" maxlength="10"></B></FONT><font face="Georgia"><img src="form-image.GIF" border="1" width="93" height="19"></font><FONT COLOR="#000080"><B>
            (enter the characters in the field)</B></FONT></CENTER>
          </DIV>
                <hr>
                <div align="center">
                  <center>
                  <font size="2">[<a href="../../../terms.htm">Terms of Service</a>] <BR>
                  </font>
                  <input style="FONT-WEIGHT: bold; " type="submit" value="Submit Quote Request"></center>
                </div>
                               <input type=hidden value="We do not fill  prescriptions for Controlled Substances!!!. All prices quoted, and orders shipped, are billed and shipped FOB New York City . No returns may be accepted for drugs and medication,  in accordance with Federal and State regulations governing prescription drugs and medications. All Prescriptions received by Phone, Fax, E-Mail, or Mail,  from Patients, Physicians,  Clinics,  Hospitals,  or other  health care professionals, are received by our Pharmacy, in New York State, and are subject to being filled under the jurisdiction and laws and regulations of the State of New York and of  appropriate Federal regulations if applicable. Delivery of your medication, regardless of the address you designate will be construed to have been made in the State of New York by our giving your order to   Airborne Express, DHL  or FedEx for delivery to you. Your transmission to us, of your prescription, and request to have the medication shipped to you at any designated address is an acknowledgement that you have read this notice and agree that New York State and Federal laws and regulation, govern and control, as to this prescription order, and  will be subject only to New York State law and jurisdiction. " >

            
          
          
          
          </TD>
    </TR>
</TABLE>
</CENTER></DIV>
            <hr color="#000080">&nbsp;<P><font color="#000080"><span style="background-color: #7DBEFF">[<a name="checkprice" href="#Quote">Back to Quote Form</a>]</span></font><BR><iframe name="I1" width="577" height="150" marginwidth="1" marginheight="1" border="0" frameborder="0" src="../DO-NOT-ALTER/search_boxpg.htm"></iframe><BR>

            </P>

          </FORM>

          </TD>
    </TR>
</TABLE>
</CENTER></DIV>

<DIV ALIGN="left"><TABLE BORDER="0" CELLPADDING="0" CELLSPACING="0" STYLE="border-collapse: collapse" BORDERCOLOR="#111111" WIDTH="100%">
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           &nbsp;</TD>
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</DIV>


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                                   <B>&nbsp;</B></TD>
                        <TD STYLE="border-top:3px double #333399; font-family: Arial; font-size: 10pt; border-bottom: 1px solid #333399; margin-top: 0; margin-bottom: 0" noWrap ALIGN="left">
                                   <B>Toll Free Phone (USA): 800-764-3648<BR>
                                   Alternate Phone: 516-467-2500<BR>
                                   Fax: 516-299-4492 Toll Free Fax (USA): 866-843-4154&nbsp;</B></TD>
                        <TD STYLE="border-top:3px double #333399; font-family: Arial; font-size: 10pt; border-bottom: 1px solid #333399; margin-top: 0; margin-bottom: 0" noWrap ALIGN="left">
                                   <B>RxUSA Administrative Office:<BR>
                                   RxUSA, Inc. (DUNS #107979960)<BR>
                                   81 Seaview Boulevard&nbsp; Port Washington, NY 11050</B></TD>
            </TR>
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                        <TD STYLE="font-family: Arial; font-size: 10pt; border-bottom: 1px solid #333399; margin-top: 0; margin-bottom: 0" vAlign="top" noWrap ALIGN="left" WIDTH="220">
&nbsp;</TD>
                        <TD STYLE="font-family: Arial; font-size: 10pt; border-bottom: 1px solid #333399; margin-top: 0; margin-bottom: 0" vAlign="top" noWrap ALIGN="left">
                                   <B>RxUSA Pharmacy HMO/PBM:<BR>
                                   81 Seaview Boulevard<BR>
                                   Port Washington, NY 11050</B></TD>
                        <TD STYLE="font-family: Arial; font-size: 10pt; border-bottom: 1px solid #333399; margin-top: 0; margin-bottom: 0" vAlign="top" noWrap ALIGN="left">
                                   <B>NYS Registration #025934<BR>
                                   NABP #333248<BR>
                                   NPI #1265537294</B></TD>
            </TR>
</TABLE>
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                                   <P ALIGN="center">
                                                             <FONT COLOR="#000000">Copyright © 2008-2010 RxUSA.com/RxUSA Inc.<BR>
                                                             &nbsp;<A STYLE="text-decoration: none" TARGET="_blank" HREF="http://insitewebdesign.com">InsitewebDesign.com</A></FONT></TD>
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