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Imprint Request Form

Do you want your own custom imprint that seperates your pharmacy from the competition? Tri State Distribution is now offerring custom imprinted caps to be ordered online! Simply fill out the form below with your store information and design request. You will then receive a composite of your personalized imprinted cap within two business days. A 10 case minimum order is required to recieve custom imprints. Allow up to 2-3 weeks for order and imprints to be completed. Feel free to look at some samples of designs we have done in the past by clicking here.

Company Information 

Customer Number:  no account? call 1-800-392-9824
Company Name: 
Contact Name: 
Phone Number: 
Fax Number: 

How would you like your composite to be sent back to you for approval?

Fax: Email:

Artwork Information

Please specify in detail the request for your custom imprint. A maximum of 2 colors can be used on the cap. Other custom text such as the company's phone number, web address, refill information, etc can also be added.

Does your company already have a logo you would like to use? If so, upload it below. There is a 250kb file size limit.


Which type of vial would you like to have imprinted?

Pro One™ Reversible Pro Plus™ Convertable



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