| Client: | |||
| Client Code: | |||
| Date: | |||
| Routine Orders | |||
| Container Type | Fill Volume | Packaged | Quantity Ordered |
| 20 mL (1/2 oz) | 10 mL formalin | 24/box | |
| 40 mL (1 oz) | 20 mL formalin | 24/box | |
| 60 mL (2 oz) | 30 mL formalin | 24/box | |
| 120 mL (4 oz) | 60 mL formalin | 24/box | |
| 500 mL (16 oz) | 250 mL formalin | 6/box | |
| 1 liter (32 oz) | 500 mL formalin | 4/box | |
| Mammoth | none | 1/each | |
| Other Supplies | Packaged | Quantity Ordered | |
| 5 gal formalin | 1/each | ||
| 1 gal formalin | 1/each | ||
| FNA Kits | 1/each | ||
| Prostate Kits | 1/each | ||
| Specimen Single Bags | 100/box | ||
| Large Multiple Specimen Bags | each | ||
| HPC Blue Requisition Forms | each | ||
|
To Fill Order Return via Courier Or Fax to (405) 844-5284 |
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