Afluria® Order Form

Please fill out the form below to order your afluria® Flu Vaccine.

An ABO representative will contact you promptly & confirm your order

Or if you would rather fax in your order, click the afluria® Vaccine Order Form below, print, complete and fax back to ABO at 949-457-0891

Required Field

Facility Name:
Contact Name:

Address:
City:
State:
Zip:

Telephone:
Fax:
Email:

Quantity: Package of ten, single-dose, 0.5-mL prefilled syringes • Thimerosal-free (mercury-free) • Latex-free
Quantity: 5-mL, latex-free, multidose vial • Contains thimerosal as a preservative • Packaged in one 10-dose vial with 10 peel-off labels attached to the vial

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