State of Delaware Not your city or county?

Due to an order delay, tags for completed licenses will be mailed in January 2025. We apologize for any inconvenience this may cause.

Licensing Supply Order

Please complete the form below to order supplies free of charge. Most supply orders are delivered within 5 business days. If you require a rush, please check "Rush Delivery" below.

Your Name:
*
Email Address:
 
Clinic Name:
*
Contact Phone:
*
Clinic Address:
*
Clinic City, State, Zip:
 

Please send the following supplies:
      URGENT! - Please Rush Delivery
Licensing Supplies
License Applications  
(triplicate)
License Tags  
(# of Tags)
Reporting Supplies
Monthly Sales Report Forms  
Monthly Reporting Envelopes  

Questions or Comments:
 
  * = Required
 

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