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MEDICAL/DENTAL SEATING SYSTEM |
ORDER FORM |
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Part # |
Description |
Qty |
Unit Cost |
Subtotal |
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1005408 |
Cushion Set; MC
400/450/550 |
225.00 |
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1005393 |
Cushion Set;
CPC 3000 |
225.00 |
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411124 |
MC 400 Mechanism |
190.00 |
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1032337 |
MC Upper Structure w/o Cushion |
360.00 |
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412033 |
Small Base w/ Castors; 400/450 |
155.00 |
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412197 |
Large Base w/ Castors; 500 |
165.00 |
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412286 |
Height Cylinder; MC 400 (short) |
85.00 |
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412097 |
Height Cylinder; MC 450 (medium) |
85.00 |
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410789 |
Height Cylinder; MC 550 (tall) |
90.00 |
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411889 |
Seat Adjustment Cylinder 400-N / 420-N |
65.00 |
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411888 |
Back Adjustment Cylinder 700-N / 720-N |
65.00 |
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411077 |
Hard Floor Castors, #62 (set of 5) |
30.00 |
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411071 |
Carpet Floor Castors, #61 (set of 5) |
30.00 |
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411578 |
Foot Ring; MC 550 |
180.00 |
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411017 |
Plastic Covers (elbow) |
25.00 |
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411017 |
Telescoping Sleeve |
25.00 |
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411063 |
Backrest Cover, outer shell only |
40.00 |
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| 410735 | Seat Cover, outer shell only | 45.00 | |||
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Left Hand Body Arm or Right Hand Body Arm |
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265.00 |
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Order Total: |
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Shipping: |
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Total: |
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| Name: | Telephone #: Fax #: |
| Address:
|
Method
of Payment: __ Visa __ MasterCard __ C.O.D. |
| Credit Card #: | |
| Signature: | Expiration Date: |
| Please
fill out the form and then return the form to us via fax or mail. Fax
to: #(901) 683-6745 When your order is received you will receive a copy to confirm the items. This confirmation will include the S & H charges, the total amount of charges for the order and the shipping date. All orders will ship via UPS Ground unless otherwise specified. Prices subject to Change without notice. Revised October 2004. |
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