Homerus Products Material Order Form - North America Customer Number:
Facility/Hospital Name: Contact Name: Phone Number: Fax Number: Email Address:
Shipping Address:
Billing Address (if different than shipping):
Delivery Date Requirement: Shipping Method: Select One FED EX Overnight (1 day) FED EX Ground (7-10 days) FED EX 2nd Day (2 days) Purchase Order #:
Parts List Quantity Part Number Description Unit Price H11496801 CANISTER ASSY, W/BLK PIN $75.00 H10614401 RIBBON, PRINTER, 3.15 IN. $56.00 H10614001 LABEL, ROLL, CASSETTE, IFILL $44.00 H10826901 LABEL, CANISTER, EASY-OFF, BULK MEDS, IPAK $44.00 H10879001 FILM, PKG, SIDE SEAM, BOPP, CLASS B, IPAK $83.00 H10527001 FILM, PACKAGING, PLEATED (1ROLL) $83.00 H11021801 TOTE, IBUNDLE $5.00 H11027901 RIBBON, PRINTER, BAGGER, IBUNDLE $43.00 H11028001 LID, TOTE, IBUNDLE $2.50 H11627503 BAG, PACKAGING, PLASTIC, 9.5" X 11" (ROLL) $90.00 H10816501 INSERT VARIETY PACK (1 PK OF 100 INSERTS) $2,290.00 H10802601 HOMERUS INSERT #1 (EACH) $23.00 H10802602 HOMERUS INSERT #2 (EACH) $23.00 H10802603 HOMERUS INSERT #3 (EACH) $23.00 H10802604 HOMERUS INSERT #4 (EACH) $23.00 H10802605 HOMERUS INSERT #5 (EACH) $23.00 H10802606 HOMERUS INSERT #6 (EACH) $23.00 H10802607 HOMERUS INSERT #7 (EACH) $23.00 H10802608 HOMERUS INSERT #8 (EACH) $23.00 H10802609 HOMERUS INSERT #9 (EACH) $23.00 H10802610 HOMERUS INSERT #10 (EACH) $23.00 H10802611 HOMERUS INSERT #11 (EACH) $23.00 H10802612 HOMERUS INSERT #12 (EACH) $23.00 H10802613 HOMERUS INSERT #13 (EACH) $23.00 H10802614 HOMERUS INSERT #14 (EACH) $23.00 H10802615 HOMERUS INSERT #15 (EACH) $23.00 Additional Comments: A Customer Support Representative will contact you with your quote shortly. Please verify that your contact information is accurate before clicking the submit button. Please feel free to contact Swisslog Customer Support at 800-396-9666 with any questions.
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