ACPL Supply Order Form

Bill To Details
Is the Ship To address the same as Bill To? *
Ship To Details
OmniVersa/E-stim System Products
Ultrasound Gels
Synchrony System Products
OmniFlow® System Products
ACPlus Respiratory Assessment (ARA) System Products
Standard Infection Control Products
Shipping *
Estimated Total: (Does not include Shipping & Taxes)
Delivery: Supplies shall be delivered FOB Origin. Buyer may choose standard ground-carrier delivery, or expedited delivery; however, the Buyer shall pay the applicable shipping charges, at ACPL published rates, to be invoiced jointly with the supply invoice.
Payment Terms: *
Accelerated Care Plus Leasing 4999 Aircenter Circle, Suite 103, Reno, NV 89502
Customer Service: (800) 350-1100, Opt. 3 Fax: (800) 350-1102 Email:
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