MICROBIOLOGY DX, INC.
19A CROSBY DRIVE, STE 215
BEDFORD, MA 01730
TEL: 781-276-4956 FAX: 781-276-6236
ORDER PAD - FORMS AND SUPPLIES
Account Name:
Account Number:
Date:
How Many
Item Description
Supplied
21 G 1 1/4" SAFETY NEEDLE
BX/60
22 G 1 1/4" SAFETY NEEDLE
BX/50
1 QUART SHARPS CONTAINER
EA
2 GALLON SHARPS CONTAINER
EA
SINGLE USE NEEDLE HOLDER
PK/250
TOURNIQUET
EA
PRINT THIS FORM AND RETURN TO LABORATORY
PLEASE ALLOW 2 BUSINESS DAYS FOR DELIVERY
QUANTITIES MAY BE RESTRICTED