2-Pack Incontinence
Sample Request Form
1.
2.
3.
4.
Fill in contact information and ordering/shipping information.
Check off the product sample desired.
Email this form to [email protected] or print this and fax it to 419-352-8340.
For specific product information or technical support call Tranquility Customer Care Center
at 1-800-467-3224 Ext. 7
Date Requested: ______________________________
Requested By: ________________________________
Email: _______________________________________
Shipping Information:
Customer Name: _________________________________
Address: ________________________________________
City: ___________________________________________
State: __________________________________________
Zip Code: _______________________________________
Disposable Underwear
2113 OverNight X-Small
2114 OverNight Small
2115 OverNight Medium
2116 OverNight Large
2117 OverNight X- Large
2118 OverNight XX- Large
17” - 28”
22” - 36”
34”- 48”
44”- 54”
48”- 66”
62”- 80”
65-85 lbs
80-125 lbs
120- 175 lbs
170- 210 lbs
210- 250 lbs
250+ lbs
20.3 fluid oz
20.3 fluid oz
34.0 fluid oz
34.0 fluid oz
34.0 fluid oz
34.0 fluid oz
2105 DayTime Medium
2106 DayTime Large
2107 DayTime X- Large
2108 DayTime XX- Large
34” - 48”
44” - 54”
48” - 66”
62” - 80”
120 -175 lbs
170- 210 lbs
210- 250 lbs
250 + lbs
25.0 fluid oz
25.0 fluid oz
25.0 fluid oz
25.0 fluid oz
2183 ATN X-Small
2184 ATN Small
2185 ATN Medium
2186 ATN Large
2187 ATN X-Large
18”- 26”
24”- 32”
32”- 44”
45”- 58”
56”-64”
18.2 fluid oz
22.2 fluid oz
27.5 fluid oz
33.0 fluid oz
34.0 fluid oz
2311 SmartCore Small
2312 SmartCore Medium
2313 SmartCore Large
2314 SmartCore X-Large
2315 SmartCore XX-Large
24”- 32”
32” - 44”
45” - 58”
56”- 64”
60” - 80”
18.0 fluid oz
24.0 fluid oz
27.0 fluid oz
29.0 fluid oz
29.0 fluid oz
2305 Breathable Medium
2306 Breathable Large
2307 Breathable X-Large
32”- 44”
45”- 58”
56”- 64”
20.4 fluid oz
21.4 fluid oz
23.7 fluid oz
2112 SlimLine Junior
2166 SlimLine X-Small
2120 SlimLine Small
2122 SlimLine Medium
2132 SlimLine Large
2134 SlimLine X- Large
28- 42 lbs
18” - 26”
24”- 32”
32” - 44”
45”- 58”
56” - 64”
10.2 fluid oz
10.9 fluid oz
12.7 fluid oz
20.4 fluid oz
21.4 fluid oz
23.7 fluid oz
Disposable Briefs
Bariatric Briefs
2190 XL + Bariatric Brief
2192 HI-Rise Bariatric Brief
2195 AIR-Plus Bariatric Brief
64”- 90”
64” - 96”
70” - 106”
34.0 fluid oz
34.0 fluid oz
34.0 fluid oz
Underpads
2074 Peach Sheet Underpad
2088 Heavy Duty Underpad
21.5” X 32.5”
30” X 36”
34.0 fluid oz
34.0 fluid oz
2709 AIR-Plus
2710 AIR-Plus
2711 Premium Plus
2712 Premium Plus
23” X 36”
30” X 36”
23” X 36”
30” X 36”
29.0 fluid oz
34.0 fluid oz
29.0 fluid oz
34.0 fluid oz
Booster Pads
2072 TopLiner Mini Booster Pad
2070 TopLiner Booster Pad
3096 TopLiner Booster Contour Pad
3097 TopLiner Super Plus Contour Pad
10.5” X 2.75”
14” X 4”
21.5” X 13.5”
32” X 14”
ThinLiner Absorbent Sheets
3090 ThinLiner 610
6” X 10”
3091 ThinLiner 714
7” X 14”
3092 ThinLiner 2022
20” X 22”
5.0 fluid oz
9.3 fluid oz
15.0 fluid oz
Personal Care Pads
2380 Super
2381 Ultimate
2382 OverNight
13.5 fluid oz
15.2 fluid oz
16.9 fluid oz
10.5” X 5.5”
13.5” X 6.5”
16.5” X 7.25”
Cleansing Wipes
3111 Travel Pack Cleansing Wipes
5.7 fluid oz
10.9 fluid oz
13.6 fluid oz
27.5 fluid oz
9” X 13”
Disposable Underwear
2603 Disposable Absorbent Underwear X-Small
2604 Disposable Absorbent Underwear Small
2605 Disposable Absorbent Underwear Medium
2606 Disposable Absorbent Underwear Large
2607 Disposable Absorbent Underwear X- Large
2608 Disposable Absorbent Underwear XX- Large
17” - 28”
22”- 36”
34”- 48”
44”-54”
48”- 66”
62”- 80”
Disposable Briefs
3665 Disposable Brief Toddler
3666 Disposable Brief X-Small
2620 Disposable Brief Small
2624 Disposable Brief Medium
2634 Disposable Brief Large
2635 Disposable Brief X-Large
28 - 42 lbs
18”- 26”
24”-32”
32”- 44”
45”- 58”
56”- 64”
9.8 fluid oz
10.4 fluid oz
11.8 fluid oz
15.8 fluid oz
19.3 fluid oz
23.0 fluid oz
Personal Care Pads
2880 Light Personal Care Pads
2881 Regular Personal Care Pads
2882 Extra Personal Care Pads
10.5” X 5.5”
13.5” X 6.5”
16.5” X 7.25”
10.1 fluid oz
11.8 fluid oz
12.6 fluid oz
Underpads
2675 Large Underpad
2677 X-Large Underpad
2679 Ultra Underpad
23” X 36”
28” X 30”
36” X 36”
8.1 fluid oz
10.6 fluid oz
18.5 fluid oz
Booster Pads
2760 Booster Pad
12” X 4.25”
6.7 fluid oz
65-85 lbs
80-125 lbs
120 - 175 lbs
170- 210 lbs
210- 250 lbs
250+ lbs
14.5 fluid oz
14.5 fluid oz
19.0 fluid oz
19.0 fluid oz
19.0 fluid oz
19.0 fluid oz