Under National Contract with
HealthTrust Purchasing Group,
Establish Direct Sales for HPG Facilities.
HPG Facilities Can Now Place Orders On-line!



Please fill in the form below to place your order today or download an order form suitable for faxing.

---

Product Order Form Select the items that you would like to order. When finished, click the "Place Order" button. It's that easy.
All fields must be completed to successfully place an order.
If you are requesting product literature, please tell us in the Comments section below, the particular products you would like additional information on.

UltiMat® Sensors
UltiMat® Sensor With EdgeSense® (bed) Sold In Cartons Of Ten (10) Each.
Standard 5 Foot Cord Length Catalog # U8500.	Quantity:
8 Foot Cord Length Catalog # U8500-8F.	Quantity:
10 Inch Cord Length Catalog # U8500-10I.	Quantity:

UltiMat® Sensors
UltiMat® Sensor (chair) Sold In Cartons Of Ten (10) Each.
Standard 4 Foot Cord Length Catalog # U5500.	Quantity:
8 Foot Cord Length Catalog # U5500-8F.	Quantity:
10 Inch Cord Length Catalog # U5500-10I.	Quantity:

BedCall® Monitors
Model BC-98 BedCall® Monitor Sold In Cartons Of One (1) Each.
Standard "Normally Open" Nurse-Call Interface Catalog # B2500.	Quantity:
"Normally Closed" Nurse-Call Interface (Bunting Systems Only / Call For Assistance) Catalog # B2500-NC.	Quantity:

ChairCall® Monitors
Optional Patient's Nurse-Call Cord for the ChairCall® Monitor Sold In Cartons Of One (1) Each.
Standard 3 Foot Cord Length; Catalog # E1202-03.	Quantity:

BedCall® Monitors
Optional Wire Holster for the BedCall® Monitor Sold In Cartons Of One (1) Each
Catalog # BH200.	Quantity:

ChairCall® Monitors
Model 3C01 ChairCall® Monitor Sold In Cartons Of One (1) Each.
Catalog # C3500.	Quantity:

Billing & Shipping Information
(If Bill To: & Ship To: are the same, please disregard "Ship To:" portion of form.)

PO #:
*Name:
Title:
Facility:
*Address:
*City: *State: AL AK AS AZ AR CA CO CT DE DC FL GA GU HI ID IL IT IN IA KS KY LA ME MH MD MA MI MN MS MO MT NE NV NJ NH NM NY NC ND MP OH OK OR PA PR RI SC SD TN TX UT VT VI VA WA WV WI WY *Zip:
Phone:
Fax:
*Email:
Comments:

Name:
Title:
Facility:
Address:
City: State: AL AK AS AZ AR CA CO CT DE DC FL GA GU HI ID IL IT IN IA KS KY LA ME MH MD MA MI MN MS MO MT NE NV NJ NH NM NY NC ND MP OH OK OR PA PR RI SC SD TN TX UT VT VI VA WA WV WI WY Zip:
Phone:
Fax:
Email:
Comments: