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Order Form

1-800-336-1414

 

Company Name
Your Name
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Shipping Address
City
State
Zip Code
Phone Number *required - in case we need to contact you
Email *required - so we can confirm your order
P.O. Number
Call for me for a Visa or MasterCard Number Sending Check -Process order when received Invoice me - I have an account or want to open one.

Please Send Us:

  Quantity

             Specifiy Color if needed

7010 Leakproof Vinyl-Terry Bibs 18" x 30"

White

7013 StainHider Bib 18" x 30"

Navy or Hunter

7020 Leakproof Vinyl-Terry Bibs 18" x 36"

White

7023 StainHider Bib 18 x 36"

Navy or Hunter

7030 Neater Eater 36" x 36"

White

7033 Neater Eater 36" x 36"

Navy or Hunter

7043 Dignity Collar

Navy or  Hunter

7050 Neater Eater 36" x 48"

White

7053 Neater Eater 36" x 48"

Navy or Hunter

7130 Nursing Carryall 10" x 9" - belt adjusts up to 51" in length

Black,  Burgundy, Gold, White or Royal

7191 "SafeSmoker" Smoker's Apron   20"w x 36"long

Black or Tan

7200 Bedpan Cover

Blue or Khaki

7205 Fracture Pan Cover

Blue or Khaki

7210 Catheter Bag Covers - Gathered Elastic Top 13" x 13"

Royal or Mint

7220 Catheter Bag Covers - Snap Fastener Closure 13" x 13"

Royal or Mint

7240 Oxygen Tubing Bag -Elastic Top w/loop for hanging 8" x 8"

Royal or Mint

7241 Oxygen Tubing Bag -Elastic Top w/Velcro for tank attachment 8" x 8"

Royal or Mint

7300 Bedpan Holster 17"w x 14"h with 4" gusset

Gray

7305 Fracture Pan Holster/"Hat" Hanger 12"w x 14"h with 4" gusset

Gray, Tan or Brown

7315 Urinal Holster 9"w x 11"h with 4" gusset

Gray

7320 Wheelchair Urinary Drainage Bag Holster 13"w x 9"h with 3" gusset

Gray

7325 TubeHider 8" x 8"

Gray or Brown

7330 Wheelchair Footrest Caddy 17" x 17"

Royal, Black,  Forest, Burgundy or Navy

7400 Leakproof Napkins 18" x 18"

Navy or Hunter

 

7520 Resident's Personal Pack 8 1/2"w x 9 1/2"h with a 4" gusset

Black, Burgundy, Gold, White or Royal
  7600 Reversible Repositioning Pads 18" x 20"    Navy/Hunter

    Navy/Hunter

 
  7601 Wong Repositioning Pads 11" x 36"   Navy/Hunter       Navy/Hunter  
7620 Mattress Block  4" x 6" x 36" Gray
7625 Extended Mattress Block 4" x 6" x 72" Gray

7610 Wheelchair Pad Cover 22" wide x 16" deep with a 4" gusset

Navy or Hunter

7751 KeepSafe Personal Security Box 5 1/2" x 15" x 4" deep Sold in lots of 3

7790 Compliance Issue Pack 2 each Oxygen Tubing Bags, Catheter Bag Covers, Bedpan Covers, 1 each Reversible Repositioning Pad and Urinal Holster

7800 The Chair Sentinel with on/off switch

7810 The Chair Sentinel without on/off switch

7815 The GeriChair Sentinel (longer Belt) with on/off switch

7816 The GeriChair Sentinel (longer Belt) without on/off switch

7825 The Bed Sentinel

7827 The BedSide Sentinel

Terms:       Net 30 with credit approval.   Visa,  MasterCard or American Express welcome.

Prices:       Prices are subject to change without notice.

Shipping:  Orders are shipped Ground unless otherwise specified.  Freight charges are prepaid and added to your invoice.

Minimum: Minimum order is $25.00  A $5.00 service charge will be added to your invoice for orders less than $25.00


If you prefer, this form may be printed and faxed to us at 1-970-249-6839