MEETING MATERIALS REQUEST FORM

MEETING MATERIALS REQUEST FORM
Date requested

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Requested delivery date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Dates of meeting
Name of meeting
REQUESTOR
Contact Name

First NameLast Name
Distributor
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
SHIPPING ADDRESS
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Fax Number
Please enter a valid fax number.Format: (000) 000-0000.
ITEMS NEEDED

ITEMS NEEDED

Rows	Quantity
Standard 6’-8’ Table Setup (Includes one (1) each Acrylic Hip and Acrylic Knee model, one (1) Klassic® Blade Stem Pull-up Banner, one (1) Klassic® Knee System Pull-up Banner, one (1) Klassic HD® Hip System Framed Photo, one (1) Klassic® Knee System Framed Photo, one (1) Black Tablecloth (Banquet), one (1) White Tablecloth (square))
Instrument Set – Klassic HD® Hip System
Instrument Set – Klassic® Knee System
Lanyard
Small Notepads
Pens
Black Tablecloth: Round
Black Tablecloth: Square
Black Tablecloth: Banquet
White Tablecloth: Round
Upcoming Meeting Flyers (set of 25)

NOTES/SPECIAL INSTRUCTIONS
SHIPPING OPTIONS
IMPORTANT

Please return all items within three (3) days after the meeting ends. By signing below you are acknowledging that you accept all responsibility for the proper care, use, and handling of these items while in your possession. Damaged or missing items will be billed to you.
Name (print)
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
TOTAL JOINT ORTHOPEDICS

MISSION-DRIVEN™

1567 East Stratford Ave.
Salt Lake City, Utah 84106
o. 888.890.0102 f. 801.486.6117 sales@tjoinc.com
Should be Empty:

REQUESTOR