Procell Order Request Form

This form is NOT an online order or online store. It is an Order REQUEST form.

This submission form sends Kathleen an order request to her email when you select the items below.

The form will show you pricing on items as they are listed in the Procell catalog (without any discount that you might earn based on your order)

Full Name:*

First NameLast Name

Business Name:*

This should be what we have on file with Procell

Practitioner License Number:*

Phone Number*

Please enter a reliable phone number that can be reached via text message.Format: (000) 000-0000.

Email*

For receipt and order confirmation

How did you hear about us?*

Delivery Address (will not accept a PO box)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

After you fill out this order request, we will contact you if we have questions or need to discuss product availability before the order is completed.

Orders submitted by 12pm EST will usually be shipped out same day (M-F) from the ProCell warehouse in Austin, TX unless otherwise noted. Be on the lookout for your email confirmation when your order is complete.

If you have any specific questions please contact Kathleen at:
(417) 595-0126
or
kathleen.carney@procelltherapies.com

Procell Products

Pro Tx Packs

PRO Tx Pack - No Aftercare

$522.00

	Qty	Price
10 Tx		$522.00
30 Tx		$1,475.00
50 Tx		$2,320.00
100 Tx		$4,350.00

Item subtotal:$0.00

PRO Tx Pack + Aftercare

$690.00

	Qty	Price
10 Tx		$690.00
30 Tx		$1,960.00
50 Tx		$3,080.00
100 Tx		$5,775.00

Item subtotal:$0.00

MD Tx Packs

MD Tx Pack - No Aftercare

$645.00

	Qty	Price
10 Tx		$645.00
30 Tx		$1,835.00
50 Tx		$2,880.00
100 Tx		$5,400.00

Item subtotal:$0.00

MD Tx Pack + Aftercare

$927.00

	Qty	Price
10 Tx		$927.00
30 Tx		$2,625.00
50 Tx		$4,120.00
100 Tx		$7,725.00

Item subtotal:$0.00

Hair Tx Packs

Hair Tx Pack + Aftercare

$1,205.00

	Quantity	Price
10 Tx		$1,205.00
30 Tx		$3,415.00
50 Tx		$5,360.00
100 Tx		$10,050.00

Item subtotal:$0.00

Devices

Pro Device (silver)

⋙ This kit contains: •Lifetime Warranty •Training Certification •1 Procell PRO Grade Device •1 Aluminum case •1 USB-C Charger & 1 Adaptor •2 USB-C Batteries •2 Tabletop Posters •25 Brochures ⋙ Training Materials: •2 HA Vials •2 Face .25mm Tips •2 Hydrating Masks

$2,995.00 Quantity
Item subtotal:$0.00

MD Device (black)

⋙ This kit contains: •Lifetime Warranty •Training Certification •1 Procell MD Grade Device •1 Aluminum case •1 USB-C Charger & 1 Adaptor •2 USB-C Batteries •2 Tabletop Posters •25 Brochures ⋙ Training Materials: •2 HA Vials •2 Face .25mm Tips •2 Hydrating Masks

$3,995.00 Quantity
Item subtotal:$0.00

Microchanneling Tips

Precision Tips

Box of 5 individually wrapped tips

$125.00

	Quantity
.25mm
0.5mm
1.0mm
1.5mm

Item subtotal:$0.00

Face Tips

Box of 5 individually wrapped tips

$125.00

	Quantity
.25mm
0.5mm
1.0mm
1.5mm

Item subtotal:$0.00

Body Tips

Box of 5 individually wrapped tips

$125.00

	Quantity
.25mm
0.5mm
1.0mm
1.5mm

Item subtotal:$0.00

Delivery Serums

PRO Serum Treatment Vials

Five (5) 2ML Microchannel Growth Factor Vials - PRO Grade

$125.00 Quantity
Item subtotal:$0.00

MD Serum Treatment Vials

Five (5) 2ML Microchannel Growth Factor Vials - MD Grade

$195.00 Quantity
Item subtotal:$0.00

Hair Growth Serum Treatment Vials

Five (5) 2ML Microchannel Growth Factor Vials- Hair

$195.00 Quantity
Item subtotal:$0.00

Aftercare

MD Trial Size Aftercare (Box of 5 pairs)

Procell Bioscience Serum System (#1 & #2) - Box of 5

$155.00 Quantity
Item subtotal:$0.00

PRO Trial Size Aftercare (Box of 5 pairs)

Procell Bioscience Serum System (#1 & #2) - Box of 5

$95.00 Quantity
Item subtotal:$0.00

MD Full Size Aftercare

Step 1: 30 ML Bottle (Contains Stem Cell Cytokines & Growth Factors)Contains twice the concentration of Growth Factors as well as added TGF beta 3 ⋙ Step 2: 30 ML Bottle (Contains Stem Cell Cytokines & Growth Factors)Contains twice the concentration of Growth Factors as well as added TGF beta 3

$155.00 Quantity
Item subtotal:$0.00

PRO Aftercare Full Size

Step 1 - Cellular Renewal Serum: 30 ML Bottle (Contains Stem Cell Cytokines & Growth Factors) ⋙ Step 2 - Healing Accelerator Serum: 30 ML Bottle (Contains Stem Cell Cytokines & Growth Factors)

$95.00 Quantity
Item subtotal:$0.00

Hair Home Care Serum 15mL Vial

15mL Vial - 2 week supply (Contains Growth Factors)

$70.00 Quantity
Item subtotal:$0.00

Mask

Hydrating Mask

Hyaluronic acid post-treatment masks- Box of 5

$40.00 Quantity
Item subtotal:$0.00

Nano Tips

.15mm Plastic MEDIUM/Face

Box of 5. These are plastic tips for serum penetration. The technique is to glide on the skin, not stamp.

$75.00 Quantity
Item subtotal:$0.00

.50mm Plastic MEDIUM/Face

Box of 5. These are plastic tips for serum penetration. The technique is to glide on the skin, not stamp.

$75.00 Quantity
Item subtotal:$0.00

Brochures and Accessories

Neuromed BLT Numbing

BLT numbing cream (benzocaine, lidocaine, tetracaine) is a triple action topical anesthetic for use by clinicians who perform minimally invasive procedures on the face and sometimes other parts of the body. BLT numbing cream is used to numb the treatment area in order to minimize the pain associated with these procedures. Some of these procedures, among others, may include: -microneedling -laser hair removal -laser tattoo removal -Ablative radio frequency

$15.00

	Quantity	Price
1 set		$15.00
5 sets		$70.00
10 sets		$120.00
25 sets (1 box)		$250.00

Item subtotal:$0.00

Device Wrapping Bags

6 X 9 Device Bags 100ct. Place the device in the bag and put the tip on by pushing it through.

$10.00 Quantity
Item subtotal:$0.00

Device wrapping tape

Black Wrapping Tape for ProCell Device.

$2.00 Quantity
Item subtotal:$0.00

Procell Retractable Banner

W24" x H62" - Retractable stand-up banner

$95.00 Quantity
Item subtotal:$0.00

Patient Brochure - Bundle of 25

$5.00 Quantity
Item subtotal:$0.00

Hair Brochure- Bundle of 25

$5.00 Quantity
Item subtotal:$0.00

USB-C Battery

USB-C Lithium-Ion Extended Life Battery

$15.00 Quantity
Item subtotal:$0.00

AUX Battery

AUX Lithium-Ion Extended Life Battery

$15.00 Quantity
Item subtotal:$0.00

AUX Power Cord

AUX Charger

$15.00 Quantity
Item subtotal:$0.00

USB-C Power Cord and Adaptor

USB-C Charger

$15.00 Quantity
Item subtotal:$0.00

Total

$0.00

What tip sizes would you like in your Tx pack?*

Products come in boxes of 5 items to a box. Please list the length AND diameter for each box. EXAMPLE: For my 10 Tx Pack: 1 box .25mm medium tips 1 box .5mm large tips

Shipping

*Shipping cost is not included in total on this form*
Shipping notice: UPS does not guarantee their shipping times during this busy holiday season. Expect delays.

Orders completed by 12pm EST will usually be shipped out same day (M-F) from the Procell warehouse in Austin, TX via UPS unless otherwise noted.

If you need expedited or next day shipping please send an email to kathleen.carney@procelltherapies.com after submitting this form.

Payment

***THIS IS NOT AN ONLINE ORDER!!!!

Payment tells us how you want to pay for the order you are requesting. Please either choose to have a link sent to you to pay OR select "card on file" and type the last 4 digits of the card you want to use that is already on file.

*Do NOT type your whole card number in this form as it is not a secure payment type form.*

Ground (3-5 business days) *free on orders over $10002-day (2 business days)Next Day (M-F delivery)

Please send me the invoice to pay onlineCard on file, last 4 digits:

E-Signature*

By typing my full name below, I certify that I am an authorized user of this Procell Account and that I will not dispute the payments with my credit card company; so long as the transaction corresponds to the products indicated in this form. To my knowledge, the information provided on this form is accurate and I will not hold Kathleen Carney (functioning as ProCell Therapies) responsible for any errors.

Special Requests?

Procell Order Request Form

Treatment Packs