s40 45 65 72 ti reorder form (062513)
DESCRIPTION
ÂTRANSCRIPT
Bill to: Ship to:
DOS:
Set Type:
DrillsQty Product No. Price (ea) Qty. Product No. Price (ea) Qty. Product No. Qty Product No. Price (ea)
S40‐20T‐11 S65‐30T‐20 K100‐11S Z402‐100‐27
S40‐22T‐11 S65‐35T‐20 K150‐11S Z402‐150‐45
S40‐24T‐11 S65‐40T‐20 K100‐14S Z400‐230‐55
S40‐26T‐11 S65‐45T‐20 K100‐16S Z401‐150‐50
S40‐28T‐11 S65‐50T‐20 K150‐16S
S40‐30T‐11 S65‐55T‐20 K150‐20S
S40‐32T‐11 S65‐60T‐20 K230‐20S
S40‐34T‐11 S65‐65T‐20 K250‐20S
S40‐36T‐11 S65‐70T‐20 K300‐20S
S40‐38T‐11 S65‐75T‐20 K230‐25S
S40‐40T‐11 S65‐80T‐20 K300‐25S
S40‐45T‐11 S65‐85T‐20 K230‐20D
S40‐50T‐11 S65‐90T‐20 K250‐20D
S40‐55T‐11 S65‐95T‐20 K300‐20D
S40‐60T‐11 S65‐100T‐20
S65‐105T‐20
S45‐20T‐16 S65‐110T‐20
S45‐22T‐16 S65‐115T‐20
S45‐24T‐16 S65‐120T‐20
S45‐26T‐16
S45‐28T‐16 S72‐50T‐25
S45‐30T‐16 S72‐55T‐25
S45‐32T‐16 S72‐60T‐25
S45‐34T‐16 S72‐65T‐25
S45‐36T‐16 S72‐70T‐25
S45‐38T‐16 S72‐75T‐25
S45‐40T‐16 S72‐80T‐25
S45‐45T‐16 S72‐85T‐25
S45‐50T‐16 S72‐90T‐25 Prices for </=4lbs Price
S45‐55T‐16 S72‐95T‐25 First a.m. (location dependent) 100.00
S45‐60T‐16 S72‐100T‐25 Priority overnight, 10:30 am 65.00
2nd Day 30.00
Note: All orders received by 3:30 pm CST will be shipped 3rd Day 22.50
the same day. Ground 13.50
If SHIPPING PREFERENCE is not checked, order will
ship via Ground service.
PURCHASE ORDER TOTAL $ ______________
Shipping & Handling Charges
Special Instructions/patient sticker:
Re‐order / Circulation FormPhone: 800‐521‐5002 | Fax: 866‐606‐4911 | Email: [email protected] | www.vilex.com
4.0 Lag Screw
4.5 Lag Screw
PO#Physician:
Patient Identifer:
7.2 Lag Screw
(Facility or
Sales Rep Address)
Facility Contact:
Price (ea)
Guide Wires (Kwires)6.5 Lag Screw
Sales Rep:Lag Screw Titanium (BLUE) ‐‐‐ 4.0, 4.5, 6.5, 7.2
Product Reference: All sizes shown in mmS‐xx‐yyT‐zz (S=lag screw, xx=screw diameter, yy=screw length, T= titanium, zz=cannulation,
Kxxx‐yyS (K=Kwire, xxx=length, yy=diameter, S=single trocar, D=Drill Tip)
Vilex Reorder Form 08/05/11