LIPOSUCTIONANDCOSMETICSURGERY
EquipmentandSupplies
ORDERFORM
Physician Name:
350 Kennedy Blvd, Bayonne, NJ 07002
tel 201-339-3996
toll free 877-339-3996
fax orders to 201-339-3997
www.camelotmedical.com
Date:
Item
Item #
Order
Unit
Qty
10103
1
1,300.00
$0.00
10481
1
4,148.00
$0.00
1
160.00
$0.00
Order
Qty
Price
Total
INFILTRATIONEQUIPMENT
InfusionPump
ASPIRATIONEQUIPMENT
Aspirator-Medela,ModelDominantFlexMobile(includesaspirator,trolley,2ea
clampholders,2ea2500mlcanisters,&overflowtrapbottlew/tubing)
CANNULAS-STAINLESSSTEEL,QUICKSCREW,VENTEDHUB
Pelosi-Avellanet,BluntTip
$0.00
$0.00
$0.00
2.5mm25cm#10003___3.0mm15cm#10006___4.0mm25cm#10005___
3.0mm25cm#10004___4.0mm30cm#10228___
3.0mm30cm#10227___
Spiral,BluntTip
1
165.00
$0.00
$0.00
$0.00
$0.00
2.5mm25cm#10421___3.0mm15cm#10331___4.0mm25cm#10009___
3.0mm25cm#10008___4.0mm30cm#10440___
3.0mm30cm#10446___
ModernSpiral,BluntTip
1
160.00
$0.00
$0.00
$0.00
2.5mm25cm#10254___3.0mm25cm#10241___4.0mm25cm#10239___
3.0mm30cm#10438___4.0mm30cm#10439___
PelosiMincer,PointedTip
1
165.00
$0.00
$0.00
$0.00
3.0mm15cm#10377___
3.0mm30cm#10477___
Saylan,SpatulaTip
1
160.00
2.5mm15cm#10025___
$0.00
$0.00
Disruptor,BluntTip
1
175.00
$0.00
$0.00
$0.00
2.5mm15cm#10027___3.0mm25cm#10138___4.0mm25cm#10029___
2.5mm25cm#10388___3.0mm30cm#10449___4.0mm30cm#10346___
AbdominalEtching
1
165.00
$0.00
3.0mm25cm#10209___
$0.00
HandlesforQuickScrewCannulas
$0.00
QuickScrewforsuctioncannula-LG
QuickScrewfordisruptor-LG
QuickScrewforsuctioncannula-SM(slimhandle)
10030
10031
10118
1 of 4
1
1
1
92.00
92.00
92.00
$0.00
$0.00
$0.00
01.01.17
LIPOSUCTIONANDCOSMETICSURGERY
EquipmentandSupplies
ORDERFORM
Item
350 Kennedy Blvd, Bayonne, NJ 07002
tel 201-339-3996
toll free 877-339-3996
fax orders to 201-339-3997
www.camelotmedical.com
Item #
Order
Unit
Qty
10092
10091
1
1
999.00
999.00
$0.00
$0.00
10062
10032
10137
10060
10040
10061
10041
10058
10042
10059
10043
10063
10044
10329
10052
10053
10074
10064
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
100.00
100.00
150.00
100.00
100.00
100.00
100.00
100.00
100.00
100.00
100.00
105.00
105.00
115.00
25.00
25.00
45.00
114.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
10243
10244
1
1
90.00
80.00
$0.00
$0.00
$0.00
10122
10123
10035
10096
10237
10113
10114
10116
10117
1
1
1
1
1
1
1
1
1
200.00
240.00
450.00
450.00
115.00
40.00
40.00
40.00
40.00
$0.00
$0.00
10229
10101
20
10
89.00
100.00
$0.00
$0.00
10076
10139
1
1
10
10
16.00
16.00
188.00
119.00
$0.00
$0.00
$0.00
$0.00
Order
Qty
Price
Total
INSTRUMENTSFORFATTRANSFER
FatGraftingSets-LuerLock
PelosiFatGraftingSet-18g(seecontentsof18gsetbelow)
PelosiFatGraftingSet-16g(seecontentsof16gsetbelow)
IndividualFatGraftingCannulas-LuerLock
16gSetContents
Multi-holetumescentinfiltration-16gx16cm
-18gx16cm
Aspirationspatulatiptwo-hole-12gx15cm
Fattransferinjectionsideport-16gx9cm
-18gx9cm
Fattransferinjectionsideportcurved-16gx9cm
-18gx9cm
Fattransferinjectionopenended-16gx9cm
-18gx9cm
Fattransferinjectionopenendedcurved-16gx9cm
-18gx9cm
FattransferinjectionV-dissector-16gx9cm
-18gx9cm
Fattransferinjection-14gx18cm
CleaningStylet-16gx18cm
-18gx18cm
TransferAdapterFemale-Femaleluer-lock
CannulaCase-autoclavable
18gSetContents
1
1
1
1
1
1
1
1
1
1
1
1
1
2
1
1
1
1
2
1
Springs
PelosiLiposuctionSpring-for60ccLuer-locksyringe
-for20/30ccLuer-locksyringe
Other
StandardFatCollectionBottlew/SiliconeStopper,autoclavable-1200cc
-2800cc
PelosiFatCollectionBottlew/Stopper,hosebarb,autoclavable-1800cc
-1000cc
FatCollectionBottleStopper,Silicone
SyringeRackAutoclavable-5cc
-10cc
-30cc
-60cc
LIPOSUCTIONSUPPLIES
AspirationTubingStandard,ribbed
AspirationTubingHi-FloPVC
CannulaCleaningBrushes
2mm#10131___3mm#10132___4mm#10133___
5mm#10134___6mm#10135___
InfiltrationPumpTubing-w/HandControl
InfiltrationPumpTubing-Standard
2 of 4
01.01.17
LIPOSUCTIONANDCOSMETICSURGERY
EquipmentandSupplies
ORDERFORM
Item
MedelaChange-overValveSet
MedelaClampholder
MedelaCanister-1500ml
-2500ml
MedelaLiner-1500ml
-2500ml
350 Kennedy Blvd, Bayonne, NJ 07002
tel 201-339-3996
toll free 877-339-3996
fax orders to 201-339-3997
www.camelotmedical.com
Item #
Order
Unit
Qty
10210
10099
10303
10304
10178
10179
1
1
1
1
120
120
70.00
17.50
49.00
57.00
357.00
373.00
1
53.00
Order
Qty
Price
Total
$0.00
$0.00
$0.00
$0.00
$0.00
COMPRESSIONGARMENTS
StandardHighWaistGirdles,Black(velcro,zipperclosure)
AboveKnee
S#10081___M#10082___L#10083___XL#10084___XXL#10085___
BelowKnee
S#10086___M#10087___L#10088___XL#10089___XXL#10090___
Ankle
S#10154___M#10155___L#10156___XL#10157___XXL#10158___
$0.00
ArmGarments-Adjustable,White
1
62.00
$0.00
$0.00
1
80.00
$0.00
$0.00
1
50.00
S#10147___M#10148___L#10149___XL#10150___
XXL#10151___XXXL#10152___
$0.00
FacialGarments
UniversalFacialBand
10
125.00
$0.00
1
35.00
$0.00
10077
10078
10079
10163
10161
10162
1
1
1
1
1
1
17.00
19.00
23.00
19.00
21.00
27.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
10306
10021
1
1
459.00
275.00
10277
10039
10279
10320
10252
10309
1
1
1
10
1
1
350.00
195.00
80.00
71.00
785.00
389.00
10308
10307
10354
1
1
1
149.00
149.00
165.00
10153
VestGarment-Male,White
S#10167___M#10168___L#10169___
Binders
AbdominalBinder9"WHITE-Small(30-45”)
-Large(45-62")
-X-Large(62-84")
AbdominalBinder12"WHITE-Small(30-45”)
-Large(45-62")
-X-Large(62-84")
ABDOMINOPLASTYINSTRUMENTS
PelosiTummyTuckRetractorw/FiberopticLightChannel
Iconoclast12"SlightCurved
COSMETICBREASTSURGERYINSTRUMENTS&GARMENTS
Agris-DingmanDissectorSet(LeftandRight)
SubglandularBreastPaddleDissector
MetcalfBreastFoldGarment
BreastBandeau
PelosiBreastEndoretractorw/Suction&LockingMechanism
SpatulaElectrode,Curvedw/Suction&TrumpetValve,monopolar
COSMETICVAGINALSURGERYINSTRUMENTS
PelosiVRRetractor-LG
-SM
DoubleCurvedNeedleHolderw/TungstenCarbide-16cm
3 of 4
01.01.17
LIPOSUCTIONANDCOSMETICSURGERY
EquipmentandSupplies
ORDERFORM
Item
-20cm
VaginalTonometer
CamelotAtraumatic,BluntDissectingScissors
350 Kennedy Blvd, Bayonne, NJ 07002
tel 201-339-3996
toll free 877-339-3996
fax orders to 201-339-3997
www.camelotmedical.com
Item #
Order
Unit
Qty
10355
10333
10311
1
1
1
Order
Qty
Price
Total
195.00
199.00
276.00
LAMINATEDPOSTERSOFCOSMETICPROCEDURES-BEFORE&AFTERPHOTOS
(Customizedposterswithyourbusiness'slogo-$200forcustomizationperposterplus$10add'lperpostercopy)
CosmeticProcedures&LiposuctionBefore&AfterPhotos-19x17"
1
10208
CosmeticFacialandNeckProceduresBefore&AfterPhotos-19.5x17"
1
10291
CosmeticBreastSurgeryBefore&AfterPhotos-19x15.5"
10221
1
BotoxCosmeticDiagramofFace-21.5x12.5"
1
10199
LipAugmentationw/FillersDiagram-18x10"
10294
1
90.00
90.00
90.00
90.00
70.00
$0.00
$0.00
$0.00
$0.00
$0.00
Total Price
50%depositonordersover$500.00,balancedueuponshipmentofyourorder.NJSalesTax(7%)appliedtoNJshippingdesfnafonsonly.Updatesofyourorderwillbe
senttotheemailaddressprovidedbelow.
DeliveryshallbeFOBorigin,andBuyershallbearallshipping,insurance,andrelatedtransportafoncharges.Allsfpulateddeliveryorshipmentdatesareesfmatesonly.
ShipmentsarenormallymadeviaUPSunlessotherwisespecifiedbytheBuyer.FreightchargesareprepaidandaddedtotheinvoiceforUPSshipments.
Allclaimsmustbemadewithin10daysofreceiptofmaterial.NoreturnwillbeacceptedwithoutapriorReturnAuthorizafonNumber(RA#).CallCustomerService
(877-339-3996)priortoreturninganyproduct.Allreturnsaresubjecttoa10%restockingfee.NORETURNSACCEPTEDAFTER30DAYS.CamelotMedicalreservestheright
torefuseunauthorizedreturnshipments.Shipmentswillbereturnedatcustomer'sexpense.Pricesaresubjecttochangewithoutnofce.
Billing Address:
First Name:
__________________________________
Shipping Address:
First Name:
! Same as Billing Address
__________________________________
Last Name:
__________________________________
__________________________________
__________________________________
Last Name:
Business Name:
Street Address:
__________________________________
__________________________________
__________________________________
__________________________________
__________________________________
__________________________________
Suite/Floor:
City:
State/Province:
__________________________________
__________________________________
__________________________________
__________________________________
__________________________________
__________________________________
Zip/Postal Code:
Country:
__________________________________
__________________________________
__________________________________
__________________________________
Payment
Information:
Business Name:
Street Address:
Suite/Floor:
City:
State/Province:
Zip/Postal Code:
Country:
Phone:
Fax:
Email address:
Shipping Preference:
! Ground (1-5 bus. Days)
! 3 Day Select (3 bus. days, by end of day)
! 2nd Day Air (2 bus. days, by end of day)
! Next Day Air Saver (by 3:00 pm)
! Next Day Air (by 10:30 am)
! Check
! Charge to credit card below:
Card #:
Exp date:
Security Code:
___________________________________
____/____
_________
Cardholder
Signature:
___________________________________
* Shipping preference will be honored provided items ordered are in stock.
4 of 4
01.01.17