ORDER FORM
Phone: 800-433-6576
Fax: 732-661-2298
MTF Account #: Account Name: PO #: Shipping Address: City: State: Rep. Name: Contact Number: DESCRIPTION
SIZE (CM)
FlexHD®
STRUCTURAL
Zip: QTY
FlexHD®
PLIABLE
QTY
FlexHD®
PERFORATED
Ultra THIN 0.2 mm – 0.4 mm
2 cm x 4 cm
4 cm x 7 cm
479204
479407
1 cm x 2 cm
2 cm x 4 cm
3 cm x 7 cm
4 cm x 12 cm
8 cm x 16 cm
8 cm x 20 cm
470102
470204
470307
470412
1 cm x 2 cm
2 cm x 4 cm
3 cm x 7 cm
4 cm x 12 cm
4 cm x 16 cm
6 cm x 12 cm
6 cm x 16 cm
6 cm x 20 cm
8 cm x 16 cm
8 cm x 20 cm
12 cm x 20 cm
16 cm x 20 cm
471102
471204
471307
471412
471416
471612
471616
471206
471816
471208
THIN 0.4 mm – 0.8 mm
HP0412
HP0816
HP0208
THICK 0.8 mm – 1.7 mm
HP1102
HP1204
HP1412
HP1416
HP1612
HP1616
HP1206
HP1816
HP1208
HP1220
HP1620
PF1416
PF1616
PF1206
PF1816
PF1208
ULTRA THICK 1.8 mm – 2.5 mm
4 cm x 12 cm
4 cm x 16 cm
6 cm x 12 cm
6 cm x 16 cm
6 cm x 20 cm
8 cm x 12 cm
8 cm x 16 cm
8 cm x 20 cm
12 cm x 20 cm
16 cm x 20 cm
BILATERAL BREAST KITS - THIN, 2 UNITS
BILATERAL BREAST KITS - THICK, 2 UNITS
472612
472616
472206
472812
472816
0.4 mm – 0.8 mm
4 cm x 12 cm
0.8 mm – 1.7 mm
4 cm x 12 cm
4 cm x 16 cm
6 cm x 12 cm
6 cm x 16 cm
6 cm x 20 cm
8 cm x 16 cm
8 cm x 20 cm
© Mentor Worldwide LLC 2014 017469-140624
HP2816
HP2208
HP2220
HP2620
PF2416
PF2616
PF2206
PF2816
PF2208
PK0412
4B1416
4B1612
4B1616
4B1816
BILATERAL BREAST KITS - ULTRA THICK, 2 UNITS 1.8 mm – 2.5 mm
4 cm x 12 cm
4 cm x 16 cm
6 cm x 12 cm
6 cm x 16 cm
4B2616
6 cm x 20 cm
8 cm x 16 cm
4B2816
8 cm x 20 cm
FlexHD ® is a registered trademark of the Musculoskeletal Transplant Foundation.
HP2412
HP2416
HP2612
HP2616
HP2206
PK1412
PK1416
PK1612
PK1616
PK1206
PK1816
PK1208
PK2412
PK2416
PK2612
PK2616
PK2206
PK2816
PK2208
RK1416
RK1616
RK1206
RK1816
RK1208
RK2416
RK2616
RK2206
RK2816
RK2208
QTY