PTS Carriers 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 4-inch Carriers/MaterialsQuantity 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/MaterialsQuantity 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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