AMD Distributor Order Form (v2.4)

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Enter the Quantity Below.

 

 Your Distributor Discount will be Applied at Billing

 % Discount Rate To Be Applied
QTY ITEM #

DESCRIPTION  (click item number for details)

REG. PRICE*

 DISCOUNT
CF-1 Chest Rest Support Foam    
CK-1 Chest Chest Rest Face Shield Kit    
CK-2 0.020 Extended Shield, Chest Rest System Kit    
CK-3 0.030 Extended Shield, Chest Rest System Kit    
CK-4 0.040 Extended Shield, Chest Rest System Kit (ANSI)    
CR-1 Chest Rest Neck Frame    
CS-1 0.020 Standard Size Shield Only    
CX-2 0.020 Extended Shield Only    
CX-3 0.030 Extended Shield Only    
CX-4 0.040 Extended Shield Only (ANSI)    
DS-2 Package of Disposable Face Shields (1 dozen)    
ES-2 Package of Eyeglass Shields (1 dozen)    
FS-1 FeatherLight Protector Face Shield Kit (w/ LCF-1 Filter)    
FS-2 FeatherLight Protector Face Shield Kit (w/ LCF-1 Filter & Extras)    
HF-3w Headframe for FeatherLight Protector (White)    
HF-3b Headframe for FeatherLight Protector (Blue)    
HF-3p Headframe for FeatherLight Protector (Pink)    
HF-3t Headframe for FeatherLight Protector (Teal)    
LCF-1 Curing Light Filter Add-on (1)    
LCF-3 Package of Curing Light Filter Add-on (3)    
NP-3 Package of No-Pric Needle Shields (6)    
RS-1 Standard Re-usable Face Shield for FeatherLight Protector    
RS-3 Package of Re-usable Face Shields for FeatherLight (3)    
SS-1 Super-size Re-usable Shield for FeatherLight Protector    
         
 

* Regular Prices Effective: Feb. 1, 2003

  
   I am authorized to order the above Amdrecor Product on behalf of the Distributor.  
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