Thank you for using the Kirby Lester KL30, KL60 or KL100. To order a cassette, you have these simple options.

1. Click here to download a Cassette Order Form (Word doc). Complete and fax the form to Kirby Lester Cassette Department at 847.984.3438 or e-mail to cassette@kirbylester.com

-OR-

2. Fill out the form below. Please complete all fields.

Your Pharmacy Information
* Mandatory fields.
* Pharmacy or Company Name:
Store Number: (if applicable)
Address:
City:
State:
Zip Code:
Country:
* Telephone:	() -
Fax:
Email:
* Ordered By:
Shipping Method:	Ground (Note: shipping costs included if applicable)
	*Overnight *Next-day *Two-day (*Additional cost)
First Cassette Information
Cassette #:
NDC:	- -
Drug Name:
Strength and Dosage Form:
Manufacturer:
Cassette Size:	SELECTStandard (650cc)High-volume (2,200cc)
Reason For New Cassette:	SELECT Jamming cassette Broken cassette New NDC New drug Other
Message:
If your order is complete, scroll to the bottom of this form and click "Submit". Otherwise, order additional cassettes below.
Second Cassette Information
Cassette #:
NDC:	- -
Drug Name:
Strength and Dosage Form:
Manufacturer:
Cassette Size:	SELECTStandard (650cc)High-volume (2,200cc)
Reason For New Cassette:	SELECT Jamming cassette Broken cassette New NDC New drug Other
Message:
If your order is complete, scroll to the bottom of this form and click "Submit". Otherwise, order additional cassettes below.
Third Cassette Information
Cassette #:
NDC:	- -
Drug Name:
Strength and Dosage Form:
Manufacturer:
Cassette Size:	SELECTStandard (650cc)High-volume (2,200cc)
Reason For New Cassette:	SELECT Jamming cassette Broken cassette New NDC New drug Other
Message:
Enter the code as it is shown. This helps prevent spamming of our form.