Page 16 - Hensler Surgical Rapid Antibody Test Teaching Module 5_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: sales@henslersurgical.com
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:
Quantity Description Unit Price Amount
Retail Kits (25 - 975 kits)
Bulk Kits (1,000 kits+)
Total:
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)
Pricing for SARS-CoV-19 Antibody (Serology via Finger-stick) 10-Minute Test Kit
$ 50.00 per Kit | Minimum order 1 Cs (25 Kits per Cs): Price: $1,250.00
$ 40.00 per Kit | Minimum order 4 Cs (25 Kits per Cs): Price: $4,000.00
$ 35.00 per Kit | Minimum order 40+ Cs (25 Kits per Cs): Price: $35,000.00
