ACPL Supply Order Form

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Ship To Details

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OmniVersa/E-stim System Products

	26122 Electrodes 2X2, Reusable, ACP OmniVersa High Conductivity Electrodes Carbon Reusable Self Adhesive (40 electrodes/box, 10 pkgs of 4) - $58.74
	26124 Electrodes 2X4, Reusable, ACP OmniVersa High Conductivity Electrodes Carbon Reusable Self Adhesive (40 electrodes/box, 10 pkgs of 4) - $80.54
	26135 Electrodes 2.75 x5, Reusable, ACP OmniVersa High Conductivity Electrodes Carbon Reusable Self-adhesive (20 electrodes/box, 10 pkgs of 2) - $79.58
	26022 Electrodes, 2X2 Reusable Uni-Patch Silver Carbon, Aloe Vera Gel Self Adhesive for Sensitive Skin (40 electrodes/box, 10 pkgs of 4) - $58.74
	26024 Electrodes 2X4, Reusable, Uni-Patch Silver Carbon, Aloe Vera Gel Self Adhesive for Sensitive Skin (40 electrodes/box, 10 pkgs of 4) - $80.54
	40944 Electrodes 4x4, Single Use, Katecho Non-gel Single Use (25 per box) - $29.95

Ultrasound Gels

86753 Ultrasound Gel, Aquasonic100, 250ml Bottle - $2.46

Synchrony System Products

	34184 sEMG Electrodes, Pharyngeal, Single-Use, (15/bx) - $74.95
	61879 sEMG Electrodes, Oro-Facial, Single-Use, (15/bx) - $74.95
	74921 PENS Electrodes, 2" Oval w/Snap, Multi-use, (10pk/bx) - $64.95
	69854 PDI, Electrode Skin Prep Pad (200 BX) - $14.95

OmniFlow™ System Products

	20912 Spirette Filter, 10/pk - $22.80
	20501 Spirettes, 10/pk - $21.00

Standard Infection Control Products

	87580 Pre-gelled Sheathes OmniVersa® Transducer Cover 2.2" x 0.8 x 8" L, 5/pk - $24
	30354 Omnisound® US Transducer Covers (NOT compatible with OmniVersa) (25ea/bx) - $29.95
	52479 Barrier Film - 4"x 6" Clear Perforated (1200sheets/rl) - $17.95
	66431 Barrier Film - 6"x 9" Clear Perforated (800sheets/rl) - $32.95
	50593 Barrier Film - 12"x 14" Clear Perforated (514sheets/rl) - $43.95
	44425 Super SaniCloth® Disposable Wipes – Tub (160 wipes/tub) - $8.95
	63574 Barrier Tubing 3" (1200'/rl) - $25.95
	13296 Head Cover, Diathermy Applicator, (100/Pk) - $12.30
	55536 Super SaniCloth® Disposable Wipes – Single use (50ea/bx) - $29.95
	59173 Wipe, PDI Super Sani-Wipe,50/BX sEMG - $14.95

Shipping *

Ground (Default)

2nd Day

Next Day

Estimated Total: (Does not include Shipping & Taxes)

$0.00

Special Instructions:

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: *

Net 30 – The Buyer shall pay for the Supplies 30 days after date of invoice, as submitted by ACPL. Invoice shall be submitted at the time the Supplies are shipped. If the Buyer does not pay the invoice when due, such invoice shall bear interest at the rate of one and one-half percent (1.5%) per month, or the maximum rate permitted by applicable law.

Credit Card – The Buyer shall pay for the Supplies with a Credit Card. Such payments shall be made at the time of purchase. Contact Customer Support (800) 350- 1100, option 3 for details.

Approved by (if applicable):

Download Safety Data Sheets

Accelerated Care Plus Leasing 4999 Aircenter Circle, Suite 103, Reno, NV 89502
Customer Service: (800) 350-1100, Opt. 3 Fax: (800) 350-1102 Email: acp-customersupport@hanger.com