Order Form (NEW) 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 samplerNot 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. Date PO # Customer / Company Name Person Ordering Referred by Phone # Email Ship to address City State Zip Receiving Person Name Receiving Person Phone # Receiving Person email Quantity VT-1000 (SoftBiopsy-V) Quantity VT-4200 (Soft K-Cot-V) Quantity VT-4500 (Soft K-Rette-V) Introductory Sample Package 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. I agree to the terms and conditions of sale and acknowledge the End User License Agreement. Submit Order Print
Shop Histologics Veterinary 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.