Kit Order – PS

Please complete the following form for your kit order. Should you have any questions in regards to filling in the form or submitting the order please feel free to contact us at 864.271.3306.

Please note that any field that is marked with an ' * ' is a required field and must be completed in order to successfully submit your order.

First Name *

Last Name *

Passphrase *

Home Phone Number *

Email Address *

Kit Type 5P -- Please select -- 5 Panel Integrated Cup (25 Kits per Box)-PS

Kit Type 8P/10P -- Please select -- 8 Panel Integrated Cup (25 Kits per Box)-Client Specific 10 Panel Integrated Cup (25 Kits per Box)-Client Specific

Quantity 5P Kits: -- Please select -- 1 Box (25 Kits) 2 Box (50 Kits) 3 Box (75 Kits) 4 Box (100 Kits) 5 Box (125 Kits) 6 Box (150 Kits) 7 Box (175 Kits) 8 Box (200 Kits) 9 Box (225 Kits) 10 Box (250 Kits) 11 Box (275 Kits) 12 Box (300 Kits) 13 Box (325 Kits) 14 Box (350 Kits) 15 Box (375 Kits) 16 Box (400 Kits) 17 Box (425 Kits) 18 Box (450 Kits) 19 Box (475 Kits) 20 Box (500 Kits)

Quantity 8/10P Kits: -- Please select -- 1 Box (25 Kits) 2 Box (50 Kits) 3 Box (75 Kits) 4 Box (100 Kits) 5 Box (125 Kits) 6 Box (150 Kits) 7 Box (175 Kits) 8 Box (200 Kits) 9 Box (225 Kits) 10 Box (250 Kits) 11 Box (275 Kits) 12 Box (300 Kits) 13 Box (325 Kits) 14 Box (350 Kits) 15 Box (375 Kits) 16 Box (400 Kits) 17 Box (425 Kits) 18 Box (450 Kits) 19 Box (475 Kits) 20 Box (500 Kits)

Gloves Nitrile Gloves (100 Gloves per Box)

Quantity Ordered Gloves -- Please select -- 1 Box (100 Gloves) 2 Box (200 Gloves) 3 Box (300 Gloves) 4 Box (400 Gloves) 5 Box (500 Gloves) 6 Box (600 Gloves) 7 Box (700 Gloves) 8 Box (800 Gloves) 9 Box (900 Gloves) 10 Box (1000 Gloves)

Ship To *

Bill To *