PPE Order Form ALL

Full Name *

First Name Last Name

Practice Name *

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Contact Number *

Area Code Phone Number

E-mail *

This offer is only available to our current members.

Member Name *

Is shipping address same as billing address? *

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Shipping Address (USPS Format)

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

1. Disposable Surgical Face Mask: 50 Piece Box (Certification CE/FDA)

2. KN95 Face Mask: 10 Piece Box (Certification CE/FDA)

3. Disposable Isolation Medical Gown | Certification CE/FDA

4. Protective Medical Isolation Gown Clothing Overalls | Certification CE/FDA

5. 75% Alcohol Wet Wipes | 160 per box | Certification CE/FDA

6. Thermometer Temperature Gun - Non Contact | Certification CE/FDA | Estimated Arrival 10 days

7. Digital Thermometer | Medical Infrared Thermometer | Certification CE/FDA

8. Safety Face Shield | Certification CE/FDA

9. Safety Medical Goggles | Certification CE/FDA

10. Safety Medical Goggles WIDE

11a. Disposable Latex Rubber Gloves SMALL (100 piece per box) | Certification CE/FDA

11b. Disposable Latex Rubber Gloves MEDIUM (100 piece per box) | Certification CE/FDA

11c. Disposable Latex Rubber Gloves LARGE (100 piece per box) | Certification CE/FDA

11d. Disposable Latex Rubber Gloves XLARGE (100 piece per box) | Certification CE/FDA

12. Disposable Medical Shoe Covers 100pc/bag | Certification CE/FDA

13. Disposable Surgical Hat Cap |100 per bag | Certification CE/FDA

14. Cotton Mask - 10 per box | USA Made

15. Face Shields with Foam Headband | 3M Material - USA Made

16. Hand Sanitizer 8 oz (250ml) 24 in a case

17. N95 Face Mask | No Longer Available

18. Gallon Hand Sanitizer

PLEASE READ BELOW AND ACCEPT BEFORE YOU PLACE YOUR ORDER:

Our medical society is dependent on your commitment made by pre-ordering to meet minimum order requirements set by our suppliers. Cancellation of an order after the group order has been placed could jeopardize the availability and time it takes to access the supply chain for the medical society.

The medical society will process the supply order once we’ve met the supplier’s minimum threshold requirement. Please note, given the volatility in the supply chains, we anticipate on average a 10-14 day acquisition timeframe from the date we place the order to the date we receive the shipment in our warehouse.

Please note that supply pricing is subject to the suppliers’ discretion and subject to change outside of the control of the medical society.

The medical society has no control over when these individual items will arrive in the warehouse. Each item will ship seperately. We will have item(s) shipped to you immediately as they arrive in the warehouse for a fee of $9 per box.

Once we’ve received the products from our supplier, a member of our team will be in contact and provide an invoice along with a credit card payment URL link and you will be notified of their anticipated delivery date.

The invoice will also include shipping, warehouse, handling fees and a credit card processing fee. All fees have been applied at our costs only.

Your order will only be released once payment has been received.

KN95 Masks

The CDC continues to include KN95 masks on their list of Personal Protective Equipment. https://www.cdc.gov/coronavirus/2019-ncov/hcp/respirators-strategy/crisis-alternate-strategies.html

The FDA has approved the use of KN95 in the US during the COVID-19 pandemic. https://www.fda.gov/medical-devices/personal-protective-equipment-infection-control/faqs-shortages-surgical-masks-and-gowns

Please acknowledge that you understand and accept the above statement regarding your order of the PPE Supplies. *

YES, I understand

Email address to send the payment url link *

example@example.com

Society *