MICROspecialties, Inc.
Product Order/Quotation Request Form Instructions

1. Please be as precise as possible. This will ensure a quick turnaround. Please refrain from comments such as, "blue drape" or 27GA cannula as we are not sure what is being requested.

2. Indicate in description if the exact item is required or if a substitute will suffice.

3. Upon clicking the "Submit" button, you will have the opportunity to review your order prior to us receiving it.

Any questions regarding our ordering process, please contact our Customer Service Department at (203) 874-1832, 9AM-5PM, Monday through Friday EST.

For a customized Eye Tray Surgical pack quote, visit our pack division website at: www.pro-paks.com

Product Order/Quotation Request

Price Quote Request
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Quotation Submitted By:        
Customer / Business          
Contact Name          
State / Provence          
Zip / Postal Code          
Special Packing Instructions:          

Quantity Description Part # Box Configuration Unit Cost Box Price

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