SAMPLE REQUEST FORM

SAMPLE REQUEST FORM
Please select what you need:

Knee Full Sample Kit (comes in carrying case)Hip Full Sample Kit (comes in carrying case)Knee Acrylic ModelHip Acrylic ModelAurum Scratch Test KitTJO Table Cloth - White and BlueTJO Table Cloth - Black and GoldTJO Table Cloth - THINKPop-Up Banner - Revision KneePop-Up Banner - AurumAugMINTS

Printed Marketing Materials

	Quantity (each)
Glamour Brochure - Cones
Glamour Brochure - Klassic ONE®
Glamour Brochure - Platform® Cup
Glamour Brochure - Aurum®
Klassic® Knee 10 Year Outcomes
Aurum® Sell Sheet
Revision TKA Sell Sheet
Klassic® Knee Early Outcomes Infographic

Other or any specifications?
Please let us know details about the meeting or event*
REQUESTOR
Requested delivery date*

MonthDayYear
*Delivery date must be at least 3 business days from the submission of this request unless approved by Marketing Team
Contact Name*

First NameLast Name
Agency*
Email*
example@example.com
Phone Number
Please enter a valid phone number.
Shipping Address*

Street Address

Street Address Line 2

CityState

Zip Code
Sample Kits must be returned within 48 hours after your event or meeting!
IMPORTANT – PLEASE READ UPON RECEIPT:

Please verify the contents of the delivered kits using the Packing Slip. Confirm that all listed items are present. If any items are missing or damaged please notify TJO Marketing

By signing below you are acknowledging receipt of all listed items, and will 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*

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Date*

MonthDayYear
Date
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