Group Purchasing Alliance Office Supply Program EZ Order Form
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1 Group Purchasing Alliance Office Supply Program EZ Order Form Phone: MAX Fax: MAX Visit us: Order Date: Address: Account Number: Phone Number: Fax Number: Credit Card Number: PIN: Attention: Consignee: P. O.: Account Name: Expiration Date: QTY UM CURRENT ITEM # DESCRIPTION PRICE* QTY UM CURRENT ITEM # DESCRIPTION Paper Products Tapes, Fasteners, Staples PK P PPR,INDEX 110#, PK A80M96708 TAPE,3/4X1296,INV,3PK EA P1OM44001 PPR,MXBRT MP,8.5X11 20# 4.79 PK A80M96709 TAPE,3/4X1296,INV,12PK CT P1OM44006 PPR,MXBRT LSR,8.5X11,24# 6.49 DZ A FLUID,CORRECT, WE,1/2 OZ CT P1OM98023-CTN PPR,OMX,92B,8.5X11,20# PK A9WOTAPP418 TAPE,WITE-OUT,WE,4PK CT P1OX9001-CTN PAPER,XERO,WE,8.5X11,20# BX H STAPLES,HALFSTRP,5000/BX BX P1Q2509A PPR,PHOT GLS,8.5X11 100P BX H4OM97032 FASTENER,PRG,SELF-ADH 2" BX P ENV, CAT 10X13 WE, 28# COMPUTER SUPPLIES BX P2OM97239 ENVELOPE,CAT,10X13,KFT EA S151649A CARTRIDGE,TRI-COLOR EA P3OM97627 NOTEBOOK,1-SUB,11X8.5, EA S1OM98669 OfficeMax C6578DN Tri-Color Cartridge (Each) RL P4OM97630 ROLL,ADD,2-1/4X128,WE 0.32 EA S1OM98673 OfficeMax C6615DN #15 Black Cartridge (Each) CT P5OM97210 BOX,STOR ECO,LTR 12CT EA S1OM98674 OfficeMax 51629A Black Cartridge (Each) CT P60M97270 PPR, CONT,1PT 9.5 X11,20# EA S151626A CARTRIDGE,PRNT,BK,DSKJET CT W TOWEL,MLTIFLD,WE,16PK/CT EA S1OM98677 OfficeMax 51645A Black Cartridge (Each) CT W TOWEL,C-FOLD, WE 10PK/CT BX S7OM98535 DISKETTES,3.5,DSHD,10/BX Folders, Files, Clips, Labels, Tabs BX S70M98536 DISKETTES,3.5,DSHD,100BX PK A2653-YW PAD,NOTE,YW1.5X2,12PD/PK 4.99 ENVELOPES & FILE FOLDERS PD A2654-YW PAD,NOTE,YW,3X BX F10M97182 FOLDER,LTR,MLA,1/3,100BX PD A2655-YW PAD,NOTE,YW,3X BX F10M97184 FOLDER,LGL,MLA,1/3,100BX PK A2686-RRYB FLAG,INDEX TAB 100/PK,AST 9.99 CT F1S11220 JACKET,FILE 2"LTR,50CT BX A LABEL, ADD 11/8X3, 2RL/BX EA F1R17A0X FILE,EXP,LTR,A-Z,INDEX BX A LABELS,SHPNG, WE 2.25X BX F1PC0EMMM INSERT,XRAY,MAMMOG,500,WE BX A LABEL,ADDRESS,2/BX,WE BX F1PC0EMNUC INSERT,XRAY,NCLR MD,500WE BX A5OM97791 LABELS,LASER,20/ BX F1PC0EMR1 INSERT,XRAY,MRI,250,WE BX A5OM97794 LABEL,LASER,6/600,WE BX F1PC0EMUS INSERT,XRAY,ULTRSND,500WE BX F FOLDER,CLSS,LTR,4PRT,BE BX F1PC0ESE INSERT,XRAY,SPINE,250,WE BX F11257GR FOLDER,CLASS,LTR,GN BX F5OM97187 FLDR,HNG,LTR,1/5TAB,25BX BX F FOLDER,CLSS,2DIV,LTR,DBE BX F5OM97190 FLDR,HNG,LGL,1/5TAB,25BX BX F17521/3 FOLDER,LTR,1/3,MLA,100BX 6.99 BX F8H10U1 FILE,1POS,3/4"EXP,50 BX F1OM97182 FOLDER,LTR,MLA,1/3,100BX 4.99 BX F8H10U13 FOLDER,LTR,2FSTNR,50/BX BX F5OM97187 FLDR,HNG,LTR,1/5TAB,25BX 4.99 BX F8H110 FOLDER,END,LTR,STR,100BX BX F8H110D FILE,SHELF,LTR,STRT, BX P2OM97225 ENV,CLASP 9X12,100BX BX H40M96606 CLIPS,PPR,PREM,#1,100BX 0.29 BX P2OM97227 ENV,CLASP10X13,100BX BX H40M96605 CLIPS,PPR,PREM,JMBO/ BX P2OM98123 ENV #10 WHT 500 COUNT OMX BX H40M96607 CLIPS,PPR,PREM,N-SKD/ BX P2OM98124 ENV WIN #10 500CT OMX BX H4OM97008 CLIP,BINDER,MED 12/BX 0.49 Pens, Pencils, Markers PK L ECONOMY VIEW BNDR 0.5"WHT 2PK 4.39 PK A GLUE STIC 26 OZ.3 PK PK L TAB,INDEX,ASST,PRINTABLE 8.29 DZ A FLUID,CORRECT,WE,1/2 OZ CT P FILE,STOR,LTR/LGL,12CT EA N B04 PEN,WEDGY,BK,EXT 5FT Receipt Books, Cups, CD's, Extension Cords DZ N PEN,VBALL,LIQ ROLLR,FN,BK CT A78J8 CUP,FOAM,8Z,25/PK DZ N PEN,VBALL,LIQ ROLLR,FN,BE EA L CORD,HANDSET,12'COIL,BK 4.81 DZ N PEN,P700 GEL,FINE,BK EA L81501 TWISSTOP,TELEPHONE,BK 7.29 DZ N PEN,P700 GEL,FINE,RD EA L CORD,UNTANGLER,WE 6.95 DZ N PEN,RBALL RT,SARSA MD,BK Page 1 of 8
2 EA L CORD,PHONE,MOD,25FT,BK 6.89 DZ N1GSF11-BK PEN,BALL,BK,F,BIC,ROUND EA P3TC1182 BOOK,RCPT 3PT,MONEY/RENT 6.99 DZ N1GSM11-BE PEN,MED,ROUNDSTIC,BE EA S PK CDR MEDIA 48X 700MB 80MIN SPINDLE DZ N1GSM11-BK PEN,MED,ROUNDSTIC,BK Desks, Chairs, File Cabinets EA N1OM97460 PEN,SECURITY,W/HOLDER EA E2EX45666CY DESK, SARATOGA, 66"MGR, CY Call DZ N MARKER,BK,F,PERM EA E5514PL FILE,4DRW, LTR,PY,W/LOCK Call ST N2GPMUP51AST MARK,ULTRA FNE 5/ST,AST EA J7DH CHAIR, CUSH ARM,HIGHBACK Call DZ N PENCIL,CLICKSTR,AST,.7MM Pricing good through December 31, 2007 *Prices are subject to change without notice. Page 2 of 8
3 Group Purchasing Alliance Office Supply Program EZ Order Form Phone: MAX Fax: MAX Visit us: Order Date: Address: Account Number: Phone Number: Fax Number: Credit Card Number: PIN: Attention: Consignee: P. O.: Account Name: Expiration Date: QTY UM CURRENT ITEM # DESCRIPTION PRICE* QTY UM CURRENT ITEM # DESCRIPTION Toner, Cartridges, Inkcart, Refils MEDICAL SUPPLIES (cont'd) Add Items As You Require Them EA S112S0400 RET PROG PRT CART-FOR E EA S151645A CTG, DESKJET, 850C,855,BK EA S1C5011DN INKJT,CTG,BLK,#14,26ML 830 PG YIELDl EA S1C6656AN CTG,INK,56,BK,DJ,5550/ EA S1C6657AN CTG,INK NO 57,P100 3CLR EA S1C6658AN140 CTG,INK,58,PHOTO,HP EA S1C7115A LSR, TONER, HP1200/ EA S1C8727AN CTG,INK NO 27,BK DJ EA S1C8766WN140 INKCART,#95 7ML TRI COL EA S1C8767WN#140 INKCART,#96 21ML BK EA S1C9351AN#140 CTG,HP INK,BK,C9351AN EA S1Q1338A LASERJET,GNUIN HP,Q1338A EA S1Q2610A CARTRIDGE,TONER, BLK EA S1Q2612A CTG,HPQ2612A,2K Yield EA S1Q5942A CTG, HP LASER, 42A, BK EA S1T5570 Pap,Ink Cart & 100 SHTS EA S RIBBON,ML590,591,BK EA S50884A003 CTG, INK,FAX,BX-3MP EA S5113R180 TONER,212/214,BK,YLD EA S51491A002AA TONER, CANON, E40,BLACK EA S51492A002AA TONER,CANON,E20,ALLINONE EA S51557A002BA TONER,FAX,CTG,FX-3,BK CT S56812A001AA TONER, CANON, PC1060/1080F EA S5DR250 DRUM,PPF2800,2900, BX S5KXFA136 CTG,FILM/INK,FAX,2/BOX EA S5KX-FA83 TONER,CTG KX KA,83 PANA EA S5PC201 FAX THERMAL PRINTING CTG,TLD 450 PAGES EA S5TN250 TONER,PPF2800,2900, EA S5TN430 TONER, LSR, PPF4750, Page 3 of 8
4 Pricing good through December 31, 2007 *Prices are subject to change without notice. Page 4 of 8
5 PRICE* Page 5 of 8
6 Page 6 of 8
7 PRICE* Page 7 of 8
8 Page 8 of 8
9 Description Mfg. Mfg # Unit GPA Price Qty Ordered Surgical Packs, Gowns, Sheets & Drapes From a GPA affiliated program Surgical Paks & Table Covers Back Table Cover Sterile 44x90 MedLine DYNJP /CS Table Cover Sterile 44 X 76 MedLine DYNJP /CS Basic Pack w/2 Gowns Sterile MedLine DYNJP1020 5/CS Basic Pack w/2 Gowns Sterile & 1 Shirt MedLine DYNJP1025 5/CS Basic Pack 1 MedLine DYNJP /CS Basic Pack w/2 Poly Gowns MedLine DYNJP1030 5/CS Universal Split Pack III MedLine DYNJP1070 4/CS Mayo Stand Cover MedLine DYNJP /CS Surgical Gowns & Drape Sheets Drape Sheet Economy 41 X 58 Sterile MedLine DYNJP /CS Drape Sheet Economy 41 X 70 Sterile MedLine DYNJP EA/CS Drape Sheet Medium Sterile 40 X 70 MedLine DYNJP EA/CS Drape Sheet Sterile 40 X 58 MedLine DYNJP EA/CS Drape Sheet Sterile Large 53 X 77 MedLine DYNJP EA/CS Drape Sheet OR Sterile Large 53 X 77 MedLine DYNJP EA/CS Gown Surgical Accent Sterile X-Lg Non-Reinforced MedLine GX EA/CS Gown Surgical Accent Sterile Lg Non-Reinforced MedLine DYNJP EA/CS Gown Surgical Sterile X-Lg Non-Reinforced w/towel MedLine DYNJP /CS Gown Surgical Velcro Sterile Lg Non-Reinforced MedLine GL EA/CS Cap Surgical, Tie Back, Kaycel, Blue 100/BX MedLine NON EA/CS Speciality Packs Head & Neck Pack Sterile MedLine ET048 7 EA/CS Head & Neck Pack Sterile OR MedLine ET058 6 EA/CS ENT Split Drape MedLine DYNJP EA/CS ENT Pack II Turban Drape MedLine DYNJP EA/CS ENT Pack MedLine ET047 7 EA/CS ENT Pack II MedLine DYNJP EA/CS Laparotomy Pack w/2 Gowns MedLine DYNJP EA/CS Laparotomy Pack w/2 Reinforced Gowns MedLine DYNJP EA/CS Laparotomy Pack No Gowns MedLine DYNJP EA/CS Laparotomy Pack No Gowns MedLine DYNJP EA/CS Breast/Chest Sheet Sterile 77 X 104 MedLine BC EA/CS Breast/Chest Drape 15 x 10 Fenestrated MedLine DYNJP EA/CS Surgical Gloves Eudermic Surgical Gloves LTX, PF Sizes BX/CS MedLine To Order: MAX 8am-9pm, et To Fax an Order: Hours PA /CS
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