Spinal Equipment and printable order form
DATE:_____________________________ORDER NUMBER:________________________
PO Box 1503
Neutral Bay
NSW 2089
Phone/Fax ORDER TO: 0500 888 020
2 Page FAX
EMAIL ORDER TO: #9; ado@ias.com.au
CONTACT DETAILS AND DELIVERY INSTRUCTIONS:
________________________________________________
________________________________________________
________________________________________________
________________________________________________
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AUTHORISED BY: .. .(name)
.. . .... . .(position)
.. .. .(sign)
SPINAL EQUIPMENT ORDER FORM
quantity
ITEM No.
DESCRIPTION
UNIT PRICE
TOTAL PRICE
SN1
Single Cervical Collar
Size:
$40
$
SN6
Set of 6 Cervical Collars in Carry Bag
$250
$
SN7
Adjustable Collar
(All adult sizes)
$65
$
SS1
Scoop Stretcher
(aluminium)
$1,650
$
SS2
Combi Scoop Stretcher (plastic)
$1,650
$
SB1
Spine Board with straps (floating)
$1.100
$
HB1
Head Bed
$550
$
SL1
Stokes Litter and Flotation Kit
$1,550
$
VM1
Vacuum Mattress and Pump
$1.150
$
AED1
Adult Extrication Device
$1,350
$
PED1
Paediatric Extrication Device
$1,150
$
ES1
Extrication Stretcher plus lifting kit
$3,900
$
FR1
Overnight Freight
$40
$40
TOTAL
$
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