Page 15 - Hensler Surgical - Biosciences COVID Rapid Testing Proposal - Facility_Clinic_Hospital - 5_6_2020
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2019-nCoV IgG/IgM Rapid Test Cassette
Order Form
13825 N Northsight Boulevard Date of Order:
Suite 101 Order Number:
Scottsdale, AZ 85260
Submit Orders to: orders@biolabsciences.net
Customer Info:
Account Name: Distributor: Hensler Surgical Technologies
Contact Name: Distributor Contact: 910.399.7380
Contact e-mail: Distributor Number: 910.599.4885
Contact Number: Sales Rep: Sean Hensler
Quantity Description Unit Price Amount
0 Retail Kits $ 0.00 $ 0.00
0 Bulk Kits $ 0.00 $ 0.00
Total: $ 0.00
Shipping Method
FedEx: Pick Up
Date to Receive: Time to Receive: Date of Pick Up:
Ship to Address: Time of Pick Up:
Address 2: By:
City:
State: Zip:
Distributed & Marketed by:
Notes:
Shipping:
FedEx Next Day 10:30 (Free on Orders $5,000.00+)
FedEx Ground (Free on Orders $2,500.00 - $5,000.00)
