Nashville Surgical Instruments


The Kumar T-ANCHORS* Hernia Set

Free Sample Request

Dear Surgeon Thank you for your interest in the Kumar T-ANCHORS* Hernia Set. The FREE Sample will be mailed to the Hospital or Surgery Center of your choice. This is necessary so that we can comply with Hospital Policies. Please ask your OR Nurse / Materials Manager to complete this Form. We will email you when the FREE Sample is mailed.

All fields Must Be Completed except P.O. Number which is Optional

Surgeon Information
Name of Surgeon:
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Please tell us how you heard about us:
Shipping Information
Hospital / Surgery Center Name
Shipping Address:
Attn:
City:
STATE:	Zip Code:
Name of Person Completing Form:
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Purchase Order Number NO DOLLAR VALUE For Traceability If Required By The Hospital

  

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