Disposables Order Form

Disposable Order Form

Name

First

Last

Phone

Ship To:

City

State/Province

Zip/Postal

Date Needed By:

Expected Return Date:

Trigger-Flex 31 (DTF-31)

Trigger-Flex 38 (DTF-38)

Trigger-Flex 40 (DTF-40)

Trigger-Flex Mini 31 (DTFM-31)

Bi-Tip (BT-FT)

Trigger-Flex Quad 18 (DTFQ-18)

Trigger-Flex Quad 24 (DTFQ-24)

Trigger-Flex Quad 31 (DTFQ-31)

Trigger-Flex Dart Short (DTFD-13)

Trigger-Flex Dart Long (DTFD-24)

Trigger-Flex Quad Pro (DTFQM-31)

16g Spine Needle (DFX-N6/1)

18g Spine Needle (DFX-N8/1)

Access Needles with Trocar Tip (N6-D5/1)

Access Needles with Beveled Tip (N6-D4/1)