Download - F50 90 reorder form (062513)
Bill to: Ship to:
DOS:
Set Type:
Qty Product No. Price (ea) Qty. Product No. Price (ea) Qty. Product No. Qty Product No. Price (ea)
F50‐35T‐20 F65‐30T‐20 F80‐70T‐20 F80‐100T‐20S
F50‐40T‐20 F65‐35T‐20 F80‐75T‐20 F80‐105T‐20S
F50‐45T‐20 F65‐40T‐20 F80‐80T‐20 F80‐110T‐20S
F50‐50T‐20 F65‐45T‐20 F80‐85T‐20 F80‐115T‐20S
F50‐55T‐20 F65‐50T‐20 F80‐90T‐20 F80‐120T‐20S
F50‐60T‐20 F65‐55T‐20 F80‐95T‐20 F80‐125T‐20S
F50‐65T‐20 F65‐60T‐20 F80‐100T‐20 F80‐130T‐20S
F50‐70T‐20 F65‐65T‐20 F80‐105T‐20 F80‐135T‐20S
F50‐75T‐20 F65‐70T‐20 F80‐110T‐20 F80‐140T‐20S
F50‐80T‐20 F65‐75T‐20 F80‐115T‐20 F80‐145T‐20S
F50‐85T‐20 F65‐80T‐20 F80‐120T‐20 F80‐150T‐20S
F50‐90T‐20 F65‐85T‐20 F80‐125T‐20 F80‐155T‐20S
F50‐95T‐20 F65‐90T‐20 F80‐130T‐20 F80‐160T‐20S
F50‐100T‐20 F65‐95T‐20 F80‐135T‐20
F50‐105T‐20 F65‐100T‐20 F80‐140T‐20 K100‐20S
F50‐110T‐20 F65‐105T‐20 F80‐145T‐20 K150‐20S
F50‐115T‐20 F65‐110T‐20 F80‐150T‐20 K230‐20S
F50‐120T‐20 F65‐115T‐20 F80‐155T‐20 K250‐20S
F65‐120T‐20 F80‐160T‐20 K300‐20S
F90‐60T‐25 K230‐25S
F90‐70T‐25 F65‐70T‐20S K300‐25S
F90‐80T‐25 F65‐75T‐20S K230‐20D
F90‐90T‐25 F65‐80T‐20S K250‐20D
F90‐100T‐25 F65‐85T‐20S K300‐20D
F90‐110T‐25 F65‐90T‐20S
F90‐120T‐25 F65‐95T‐20S Z402‐100‐27
F90‐130T‐25 F65‐100T‐20S Z402‐150‐45
F90‐140T‐25 F65‐105T‐20S Z400‐230‐55
F90‐150T‐25 F65‐110T‐20S
F90‐160T‐25 F65‐115T‐20S
F90‐200T‐25 F65‐120T‐20S
F90‐250T‐25 PriceFirst a.m. (location dependent) 100.00
Note: All orders received by 3:30 pm CST will be shipped Priority overnight, 10:30 am 65.00
the same day. 2nd Day 30.00
If SHIPPING PREFERENCE is not checked, order will 3rd Day 22.50
ship via Ground service. Ground 13.50
PURCHASE ORDER TOTAL $ ______________
Prices for </=4lbs
Re‐order / Circulation FormPhone: 800‐521‐5002 | Fax: 866‐606‐4911 | Email: [email protected] | www.vilex.com
5.0 Dual Thread (Headless) 6.5 Dual Thd (Headless)
PO#
Special Instruction:
All sizes shown in mmF‐xx‐yyT‐zzS (F=dual thread, xx=screw diameter, yy=screw length, T or Ti= titanium, zz=cannulation, S=Short
Thrd) Kxxx‐yyS (K=Kwire, xxx=length, yy=diameter, S=single trocar, D=Drill Tip)
Shipping & Handling Charges
Drills
Physician:
Patient Identifer:
8.0mm SHORT THREAD
(Facility or
Sales Rep Address)
Facility Contact:
Price (ea)
8.0 Dual Thread (Headless)
Sales Rep:Dual Thread (Headless) Titanium (GREEN) ‐‐‐ 5.0, 6.5, 8.0, 9.0
Guide Wires (Kwires)
6.5mm SHORT THREAD
9.0mm Dual Thrd (Headless)
Product Reference:
Vilex Reorder Form 08/05/11
