LoCost Printable Order Form

How to submit your order for processing:

1. Complete the Order Form electronically and email it to our Customer Assurance Team at cs@locostmedicalsupply.com, or
2. Print the Order Form, fill the form out, and fax it to 855-456-2678

Questions? Call our Customer Assurance Team at 1-(888)-679-1145

*Ensure the payment method field is correctly filled out; forms without correct or complete payment methods will resuld in delayed processing*

Click here to Download LoCost Printable Order Form