Contact us:
News
IP
Quality
About Us
Contact
Sample Request
*
Indicates required field
Requester (You)
*
First
Last
This is you
Send Samples to:
*
First
Last
Who do you want the samples sent to:
Reason
*
Sales rep. request for evaluation
Direct customer interest
Subsidize trade show
Distributor training
Other (detail in comments)
Why are we sending samples?
Where to ship (Address)
*
Line 1
Line 2
City
State
Zip Code
Country
What to send (choose multiple)
*
44F50-10 VibraPEP, Box of 10 EA
44F50-1 VibraPEP, 1 EA
44F10-10 VibraPEP NO TEE, Box of 10 EA
44F10-1 VibraPEP NO TEE, 1 EA
LIT-3332 Poster, VibraPEP with 22mm Cap Adaptor 1 EA
LIT-3338 Poster, Physician Office Lavender
LIT-3345A Publication, Variability in OPEP expiratory flow requirements
LIT-3332 Poster w/cap adapter
44F50-DEMO-KIT VibraPEP Demonstration Kit - Not for Resale, 1 EA/EA
MKT-0003 Pen, VibraPEP promotional 10 EA/PK
Marketing Brochure
Table top banner
Floor Banner
Table Drape (enter quantity in notes)
Small volume nebulizers
Stickers
Demo Bags
Select items to send. If you don't see what you want make a comment
Special request?
*
Please indicate quantity
Who pays freight
*
Customer
Distributor
Medica
Other
Shipping
*
Ground Service
3 Day select
2 Day
Next day
Other
Will Call
How fast does the receiver need the samples?
Freight Carrier Account Number
*
Sarnova FedEx 108051795
Medica UPS 20Y4R7
Other (specify in comments)
No Charge PO required?
*
No
Yes
If sending into an account is a no charge purchase order required to get the samples to the customer?
PO #
*
Comment
*
Submit
