PTS Carrier Order Form

PTS Carriers
Material Order Form - North America

Customer Number:

Facility/Hospital Name:
Contact Name:
Phone Number:
Fax Number:
Email Address:

Shipping Address:

    Attention:
    Street Address:

    City:                          State:    Zip:

Billing Address (if different than shipping):

    Attention:
    Street Address:

    City:                        State:    Zip:

Delivery Date Requirement:
Shipping Method:
Purchase Order #:

Parts List
4-inch Carriers/Materials
Quantity      Part Number    Description
    75171005               4-inch Universal Carrier
    75171009               4-inch Universal Frosted Carrier
    75171007               4-inch 1/2 Black Carrier
    75171008               4-inch Black Carrier
    76129301               4-inch Cleanout Bottle
    76127803               4-inch Thin Liner Set (set of 5)
    76127801               4-inch Full Liner Set (set of 5)
    76113702               4-inch Wear Band Replacement Kit
                                                    (repairs 25 carriers)
    76139402               4-inch Wear Band Replacement Kit
                                                    (repairs 10 carriers)
   76131902               Small Biohazard Pouches w/Insert
                                                    (set of 5)
   76131904               Small Biohazard Pouches w/o Inserts
                                                    (set of 5)
   76132901               Inserts (set of 5)
   76136201               Small Clean Pouch (1 each)

6-inch Carriers/Materials
Quantity      Part Number    Description
    75508111               6-inch Universal Carriers w/Durabands
    75508112               6-inch Universal 1/2 Black Carrier
    75508113               6-inch Universal Black Carrier
    75508114               6-inch Universal Frosted Carrier
    75508115               6-inch Universal RFID Carrier
    75508116               6-inch Universal 1/2 Black RFID Carrier
    75508117               6-inch Universal Black RFID Carrier
    75508118               6-inch Universal Frosted RFID Carrier
    76138902               6-inch Universal Latch Replacement Kit
                                                    (repairs 10 carriers)
    76121901               6-inch Carpet Wear Band Kit
                                                    (repairs 10 carriers)
    91074801               Adhesive for Carpet Wear Bands (1 qt)
    91153201               Band Clamps
                                                    (to install carpet wear bands)
    75510101               6-inch Eco-Seal Clear Carrier
    75510103               6-inch Eco-Seal 1/2 Black Carrier
    75510102               6-inch Eco-Seal Clear RFID Carrier
    75510105               6-inch Eco-Seal Frosted Carrier
    75510104               6-inch Eco-Seal 1/2 Black RFID Carrier
    75510106               6-inch Eco-Seal Frosted RFID Carrier
    76141103               Green DuraBand Repl Kit for Eco-Seal
                                                    (repairs 10 carriers)
    76150501               Blue DuraBand Repl Kit for Eco-Seal
                                                    (repairs 10 carriers)
    76146202               6-inch Eco-Seal Latch Repl Kit for
                                                   Eco-Seal (repairs 5 carriers)
    76146301               O-Ring Replacement Kit (Green Durabands)
                                                    (contains 5 o-rings)
    76150401               O-Ring Replacement Kit (Blue Durabands)
                                                    (contains 5 o-rings)
    94140501               Biohazard Carrier Label Set
                                                    (minimum order qty of 5)
    76146102               Latch Installation Tool
    76127904               6-inch Thin Liners (set of 5)
    76127901               6-inch Full Liners (set of 5)
    76129302               6-inch Cleanout Bottle
    76131901               Large Biohazard Pouches w/Inserts
                                                    (set of 5)
    76131903               Large Biohazard Pouches w/o Inserts
                                                    (set of 5)
    76132901               Inserts (set of 5)
    76136101               Large Clean Pouch (1 each)

*Quantity discounts are available.

Additional Comments:

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