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Quotation Request |
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| Name: * |
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Position/Job Title: |
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Company Represented: |
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Website: |
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| Mailing Address: Email Address: * |
Phone Number: Fax Number: |
| Description | Catalogue No. | Packaging | Quant. | ||||
| PT-HS (ISI ~ 1.0 - 1.4) | HEM-10100-BLK | 500 | X | 2 | mL | Vials | |
| PT-HS (ISI ~ 1.0 - 1.4) | HEM-10101-BLK | 500 | X | 4 | mL | Vials | |
| PT-HS (ISI ~ 1.0 - 1.4) | HEM-10111-BLK | 500 | X | 10 | mL | Vials | |
| APTT - Ellagic Acid | HEM-10201-BLK | 500 | X | 4 | mL | Vials | |
| APTT - Ellagic Acid | HEM-10211-BLK | 500 | X | 10 | mL | Vials | |
| Calcium Chloride 0.02M | HEM-10401-BLK | 500 | X | 4 | mL | Vials | |
| Calcium Chloride 0.02M | HEM-10411-BLK | 500 | X | 10 | mL | Vials | |
| Level 1 Control | HEM-20101-BLK | 500 | X | 1 | mL | Vials | |
| Level 2 Control | HEM-20201-BLK | 500 | X | 1 | mL | Vials | |
| Level 3 Control | HEM-20301-BLK | 500 | X | 1 | mL | Vials | |
| Which categories best describe your business/position (Please check all that apply) | |||||
| Distributor | Hospital | Government | Laboratory | Clinic | NGO |
Other: |
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| How else may we assist you? | |||
| Send catalogue | Send sample | Demonstration Required | |
| Other Requests (specify details): |
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