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Order Form (NEW)

Order Form
Kylon® Fabric-Based Advanced Veterinary Care Devices
ORDER FORM
CUSTOMER AND SHIPPING INFORMATION
Date:
PO #:
Customer / Company Name:
Person Ordering:
Referred by:
Phone #:
Email:
Ship to address:
City:
State:
Zip:
Product will ship via FedEx - To receive tracking notification, please fill in information for the person receiving the product
Receiving Person Name:
Phone #:
Receiving Person email:
Shipping Continental US: $15.00 per box (up to 250 units per box), Shipping California Customers only: $10.00 per box
All Orders: $5.00 Handling Charge Per Box (up to 250 units per box); Alaska, Hawaii, Puerto Rico - call for rates
Volume Discounts Available:
$5.50/ea. for 250 or more devices
Can be a combination of device types
$5.25/ea. for 1000+ devices
Additional Discounts available for orders over 5000 units
25 Unit Minimum Purchase
DEVICE NAME
ITEM NUMBER
DESCRIPTION
PRICE PER UNIT
QUANTITY
SoftBiopsy®-V
VT-1000
Biopsy brush tissue sampler
Not for debridement
$5.75 each
Soft K-Cot®-V
VT-4200
Finger cot brush-curette for wound hygiene, debridement, and tissue biopsy sampling
$5.75 each
Soft K-Rette®-V
VT-4500
Brush-curette for interdigitary or wound crevice debridement and tissue sampling
$5.75 each
PAYMENT INFORMATION
ORDER SUBMISSION / PRODUCT SUPPORT
Invoices will be sent via e-mail with secure online options for credit card payment. If you prefer, you can mail a check to:
Histologics, LLC 4095 E. La Palma Ave., Suite N
Anaheim, CA 92807
Fax: 1-888-738-9757 or scan and email form to:
This email address is being protected from spambots. You need JavaScript enabled to view it.
Customer Support: 888-235-2275 / This email address is being protected from spambots. You need JavaScript enabled to view it.
Request a sample pack of our veterinary devices with your order: 3× SoftBiopsy-V, 3× Soft K-Cot-V, 2× Soft K-Rette-V. One per customer.

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Order Online to Buy smaller quantities directly on this website. Sales Reps for distributors and or large quanty inquries for Executive Sales Accounts. Order by PDF abd Download, Print, Complete, Scan, then Email or Fax.