Ship To Information                                                                Billing Information (if different from Contact)

Ordering Information

Ultrasound Gel Products

(click on the type/s/ and quantity of printer you would like to purchase)

Ultrasound Gel Products                                                                                                            Quantity     

  None Parker Aquasonic® 100 - 60g Tubes 01-02 Parker Aquasonic® 100 - 1L Dispensers 01-34 Parker Aquasonic® 100 - 5-L SONIPAC  01-50 Parker Aquasonic® 100 - 0.25L dispensers 01-08 Parker Sterile Full Pouches 01-01 Parker AQUAFLEX Stand-Off Pads 04-02 Parker Sterile CLEAR Aquasonic® 100 - 250ml Dispensers 03-08 Parker Sterile CLEAR Aquasonic® 100 - 5L Sonipac 03-50 Parker Sterile CLEAR Aquasonic® 100 - 60g Tubes 03-02 Parker Sterile CLEAR Aquasonic® 100  - 1L Dispensers 03-34 Parker Sterile CLEAR Aquasonic® 100 - ECONOPAC 03-54 Parker SCAN Gel - 1 U.S. Gal 11-28 Parker SCAN Ultrasound Gel  - SCANPAC 11-28S Parker SCAN Gel  - 250ml Dispensers 11-08 Parker Polysonic® Lotion - 8.5oz Bottles 21-08 Parker Polysonic® Lotion - 1 U.S. Gallon 21-28 Parker Polysonic® Lotion - POLYPAC 21-50 Parker Polysonic® Lotion w/ Aloe - 8.5oz bottles 20-08 Parker Polysonic® Lotion with Aloe - 1 Gal 20-28 Parker Polysonic® Lotion with Aloe - POLYPAC 20-50 Parker Aquagel® Lubricating Gel - 142g Tube 57-05 Parker Aquagel® Lubricating Gel - 2L Dispenser 57-20                           1 2 3 4 5 6 7 8 9 10 20 0    

Enter competitor's lower price and place where it can be validated in box below.  (NOTE:  IF NOTHING IS ENTERED, PRICE OFF OF SCIENTIFIC DIGITAL IMAGING WEB PAGE WILL BE USED)

Ultrasound Gel Products                                                                                                            Quantity     

  None Parker Aquasonic® 100 - 60g Tubes 01-02 Parker Aquasonic® 100 - 1L Dispensers 01-34 Parker Aquasonic® 100 - 5-L SONIPAC  01-50 Parker Aquasonic® 100 - 0.25L dispensers 01-08 Parker Sterile Full Pouches 01-01 Parker AQUAFLEX Stand-Off Pads 04-02 Parker Sterile CLEAR Aquasonic® 100 - 250ml Dispensers 03-08 Parker Sterile CLEAR Aquasonic® 100 - 5L Sonipac 03-50 Parker Sterile CLEAR Aquasonic® 100 - 60g Tubes 03-02 Parker Sterile CLEAR Aquasonic® 100  - 1L Dispensers 03-34 Parker Sterile CLEAR Aquasonic® 100 - ECONOPAC 03-54 Parker SCAN Gel - 1 U.S. Gal 11-28 Parker SCAN Ultrasound Gel  - SCANPAC 11-28S Parker SCAN Gel  - 250ml Dispensers 11-08 Parker Polysonic® Lotion - 8.5oz Bottles 21-08 Parker Polysonic® Lotion - 1 U.S. Gallon 21-28 Parker Polysonic® Lotion - POLYPAC 21-50 Parker Polysonic® Lotion w/ Aloe - 8.5oz bottles 20-08 Parker Polysonic® Lotion with Aloe - 1 Gal 20-28 Parker Polysonic® Lotion with Aloe - POLYPAC 20-50 Parker Aquagel® Lubricating Gel - 142g Tube 57-05 Parker Aquagel® Lubricating Gel - 2L Dispenser 57-20                          1 2 3 4 5 6 7 8 9 10 20 0    

Enter competitor's lower price and place where it can be validated in box below.  (NOTE:  IF NOTHING IS ENTERED, PRICE OFF OF SCIENTIFIC DIGITAL IMAGING WEB PAGE WILL BE USED)

Payment Information

Purchase Order Number   

OR

Name exactly as it appears on credit card   

Address to which credit card bill is sent       

Zip Code to which credit card bill is sent     

Credit Card Type            VISA MasterCard American Express None Selected

Credit Card Number      

Expiration Date:   Month None Selected 01 02 03 04 05 06 07 08 09 10 11 12     Year None Selected 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020

Shipping & Handling

Type of Shipping & Handling Requested        

  Ground (2-5 Business Days depending on your location)

  3-Day

  2-Day

  Standard Next Day (by 3:30pm)

  Priority Next Day (by 10:30am)

(If None Selected, order will go by "Ground")

(NOTE:  Shipping/Handling charges are billed as the cost charged by shipper.  Charges are dependent upon number of boxes and type of paper purchased.)

Comments/Other Information Requested

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