Shop 3 / 31 Murradoc Rd Drysdale Vic 3222 P.O Box 539 Drysdale Vic 3222 P. 03 5251 3229 F. 03 5251 2233 [email protected] www.vorotek.com.au ABN: 37 542 190 302 VOROTEK ACCESSORIES ORDER FORM Conference (If applicable): DATE PURCHASE ORDER # Contact Name: Company: Billing Address: Delivery Address: Phone: Mobile: Fax: Email: End user details (If not as above) Name of end user: Phone: Email: CODE ITEM / DESCRIPTION QUANTITY PRICE Wax Rings. Stainless Steel VIWR-2.0 2.0mm ring VIWR-2.5 2.5mm ring VIWR-3.0 3.0mm ring VIWR-3.5 3.5mm ring VIWR-4.0 4.0mm ring VIWR-4.5 4.5mm ring 90 deg Hooks. Stainless Steel VIH-S Small 90deg hook VIH-L Large 90deg hook VIWC Wool Carrier. Stainless Steel VOTM O Scope Teaching Mirror VSPO Pneumatic Otoscope. VSPO-S15 Pneumatic Otoscope & Speculum set With 6 diopter lens Incl - Pneumatic Otoscope with 6 dioptre lens and 15 autoclavable speculums (3 of each size XS, X, M, L, XL). Speculums. Autoclavable plastic VPS-XS XS plastic speculum VPS-S S plastic speculum VPS-M M plastic speculum VPS-L L plastic speculum VPS-XL XL plastic speculum VPS-S15 Speculum Set Incl - 15 speculums made up of 3 of each size (XS, X, M, L, XL). Autoclavable plastic VPS-B100 VPS-B500 VPSD VPSD-B500 VPSD-K Speculum Bulk Orders 100 x Speculums. Autoclavable plastic 500 x Speculums. Autoclavable plastic Speculum Dispenser. Wall mounted Speculums & Dispenser Incl - 500 Speculums & Wall mounted dispenser. Clinic Dispenser Kit Incl - Wall mounted Dispenser, 500xSpeculums, 1xPneumatic Otoscope, 5xWax Rings, 2xHooks & 1xWool Carrier. TOTAL: COMMENTS: CREDIT CARD DETAILS - VISA or MASTERCARD NAME ON CARD: EXPIRY DATE: SIGNATURE: Made in Australia
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