s40 45 65 ss reorder form (062513)
DESCRIPTION
ÂTRANSCRIPT
Bill to: Ship to:
Facility
Contact:
All sizes shown in
mm
Qty Product No. Price (ea) Qty. Product No. Price (ea) Qty. Product No. Price (ea)S40‐20S‐14 S65‐30S‐20 K100‐11S
S40‐22S‐14 S65‐35S‐20 K150‐11S
S40‐24S‐14 S65‐40S‐20 K100‐14S
S40‐26S‐14 S65‐45S‐20 K100‐16S
S40‐28S‐14 S65‐50S‐20 K150‐16S
S40‐30S‐14 S65‐55S‐20 K150‐20S
S40‐32S‐11 S65‐60S‐20 K230‐20S
S40‐34S‐14 S65‐65S‐20 K250‐20S
S40‐36S‐14 S65‐70S‐20 K300‐20S
S40‐38S‐14 S65‐75S‐20 K230‐20D
S40‐40S‐11 S65‐80S‐20 K250‐20D
S40‐45S‐11 S65‐85S‐20 K300‐20D
S40‐50S‐14 S65‐90S‐20
S40‐55S‐14 S65‐95S‐20 Z402‐100‐27
S40‐60S‐14 S65‐100S‐20 Z402‐150‐45
S65‐105S‐20 Z400‐230‐55
S45‐20S‐16 S65‐110S‐20
S45‐22S‐16 S65‐115S‐20 Special Instructions/Patient Sticker:S45‐24S‐16 S65‐120S‐20
S45‐26S‐16
S45‐28S‐16 S65‐70S‐20S
S45‐30S‐16 S65‐75S‐20SS45‐32S‐16 S65‐80S‐20SS45‐34S‐16 S65‐85S‐20S
S45‐36S‐16 S65‐90S‐20S
S45‐38S‐16 S65‐95S‐20S
S45‐40S‐16 S65‐100S‐20S
S45‐45S‐16 S65‐105S‐20S
S45‐50S‐16 S65‐110S‐20S
S45‐55S‐16 S65‐115S‐20S
S45‐60S‐16 S65‐120S‐20S
Note: All orders received by 3:30 pm Prices for </=4lbs PriceCST will be shipped the same day. First a.m. (location dependent) 100.00
Priority overnight, 10:30 am 65.00If SHIPPING PREFERENCE is not checked, 2nd Day 30.00order will ship via Ground service. 3rd Day 22.50
Ground 13.50
PURCHASE ORDER TOTAL $ ______________
Re‐order / Circulation Form
Guide Wires (Kwires) & Drills
S‐xx‐yyS‐zzS (S=lag screw, xx=screw diameter, yy=screw length, S=stainless, zz=cannulation, S=Shrt Thrd)
Kxxx‐yyS (K=Kwire, xxx=length, yy=diameter,S=single trocar, D=Drill Tip)
6.5mm Lag Screw Shrt Thrd
Drills
4.5 mm Lag Screw
PO#
Lag Screw Stainless (SILVER) ‐‐‐ 4.0, 4.5, 6.5
Phone: 800‐521‐5002 | Fax: 866‐606‐4911 | Email: [email protected] | www.vilex.com
Sales Rep:
(Facility or
Sales Rep
Address)
Shipping & Handling Charges
Set Type:
Physician:
Patient Identifer:
Product Reference:
DOS:
4.0 mm Lag Screw 6.5 mm Lag Screw
Vilex Reorder Form 08/05/11