Date
Submitter
Address
Contact
Email
Telephone
Your P.O. or
Reference
Advertiser
Product
Clearance Category






Turnaround (applies to clearance categories ONLY)


Consumer Drug and NHP turnaround


Route to (please allow 72 hr turnaround)



Type of Advertisement






Medium





Length/No.of Scripts







Language





+ please include translation
Other





Titles/I.D. codes
Previous Numbers (if applicable)


635 QUEEN STREET EAST, TORONTO, ONTARIO, CANADA , M4M 1G4 TEL: 416.964.7539 FAX: 416.778.5989 TOLL FREE: 1.800.463.6456 email: clearances@mijo.com