Please submit a separate form for each tray you want quoted.

We pride ourselves in the fact that we can provide a custom single shot tray for less then what other manufacturers charge for stock trays. In an effort to demonstrate our goal, please fill out our CREATE-A-KIT form and we will send you a price quote and sample of your custom tray for your review. If we have not listed a component that you would prefer in your tray please put a description of what you like in our comment window at the bottom of our form.

Step 1: Complete the following company information

Company/Customer Name:
Address:
City,State,Zip:
Telephone:
Fax:
Email:

Step 2: Indicate the Quantity of Desired Products.

EPIDURAL NEEDLES  WINGED  HUSTEAD    TUOHY  MARKED  FIXED WING    DETACHABLE WING    17GA X 3-1/2"  18GA X 3-1/2"  20GA X 3-1/2"  22GA X 3-1/2" LOSS OF RESISTANCE SYRINGES  LUER LOCK    LUER SLIP  GLASS SYRINGE 5CC  GLASS SYRINGE 10CC  PLASTIC SYRINGE 7CC SYRINGES  LUER LOCK    LUER SLIP  SYRINGE 1CC  SYRINGE 3CC  SYRINGE 5CC  SYRINGE 10CC  SYRINGE 20CC NEEDLES  NEEDLE 18GA X 1-1/2"  FILTER NEEDLE 19GA X 1-1/2"  NEEDLE 20GA X 1-1/2"  NEEDLE 21GA X 1-1/2"  NEEDLE 22GA X 1-1/2"  NEEDLE 25GA X 5/8"  NEEDLE 25GA X 1-1/2"  NEEDLE 27GA X 1-/12"

MEDICATIONS  LIDOCAINE 1% 2ML AMPULE  LIDOCAINE 1% 5ML AMPULE  LIDOCAINE 1.5% w/ 1:200. EPI  LIDOCAINE 2% 10ML AMPULE  SENSORCAINE .25% VIAL  SENSORCAINE .50% VIAL  SODIUM CHLORIDE 0.9% 10ML AMPULE  SODIUM CHLORIDE 0.9% 5ML AMPULE DRAPES & TOWELS  GENERIC FENESTRATED DRAPE  SMALL FENESTRATED DRAPE w/TAPE  LARGE FENESTRATED DRAPE w/TAPE  CLEAR FENESTRATED DRAPE  CLEAR FENESTRATED DRAPE w/ADHESIVE  ABOSORBENT TOWEL  TOWEL DRAPE w/POLY PREP PRODUCTS  SPONGE APPLICATORS  POVIDONE IODINE 10Z. PACKET  POVIDONE IODINE TRIPLE SWABS  ALCOHOL TRIPLE SWABS  ALCOHOL PREP PAD  GAUZE 4 X 4-8 PLY  GAUZE 3 X 3-12 PLY  BAND AID  NEEDLE STICK PAD EXTENSION SETS  EXTENSION SET 6" SMALL BORE  EXTENSION SET 6" MICRO BORE  EXTENSION SET 12" SMALL BORE  EXTENSION SET 12" MICRO BORE

Step 3: Indicate the estimated monthly usage

Step 4: Indicate which you would prefer

Non-Sterile Sample   Sterile Sample

Step 5: Additional Comments

Step 6: Enter code (case-sensitive)

Step 7:

Submit for Quote and Sample