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phone:

1-800-328-8908

| fax:

1-800-369-9207

| online:

www.cresthealthcare.com

| 2015 |

F35

Carts & Storage

225-235

General Purpose

& Housekeeping Carts

226-227

Wire Carts & Shelves

227-229

Linen Carts

230-231

Hampers

232

Emergency & Med Carts

233-235

Security &

236-264

Maintenance

Anti Wandering Devices

237-240

Exit Signs & Fire Alarms

241-244

Electrical Supplies

245-250

Signage & Wall Guards

251-264

Bed Locators

264

Policies & Warranties

265

Index

266-268

Repairs

269

Curtain Order Form

270

Sign Order Form

271

Order Form

272

Biomed &

201-224

Respiratory

Scales

202-204

Thermometers

205

Pulse Ox

206

Stethoscopes & Sphygs

207-214

Oxygen Supplies

217-220

Glove Box Holders

& Hygiene Stations

222-223

Sharps Containers

224

Visit Crest online for 24-hour ordering, technical resources,

videos, white papers and our virtual online catalog.

www.cresthealthcare.com

272

phone:

1-800-328-8908

|fax:

1-800-369-9207

|online:

www.cresthealthcare.com

|2015 |

F35

CrestHealthcareSupply

®

OrderForm

CIRCLEPAYMENTMETHOD:

CHECKWITHORDER

PLEASESEND INVOICE

(subject to creditapproval)

C.O.D

(U.S.FUNDSONLY)

CREDITCARD:

DISCOVER, MASTERCARD, VISA, AMERICANEXPRESS

CIRCLESHIPPINGMETHOD:

GROUND

1-Day

2-Day

3-Day

OTHER

l.

**Not required ifyourTaxExemptCertificate ison fileatCrest.

***Shipping chargesarepre-paidbyCrestandadded toyour invoice. Ifpayment is

"checkwithorder," callour toll-freenumber for shipping charges.

Note:

Customer is responsible foranyadditional taxesor feesassociatedwith

internationalorders.

*

Pricesmay changewithoutnotice.

Sub total

CA,FL,MN residentsaddapplicable

sales tax**

Shipping charges ***

TOTALAMOUNT

QTY.

PARTNO.

COLOR

DESCRIPTION

UNITPRICE

*

TOTAL

(whenapplicable)

OrderByMail:

CrestHealthcareSupply

195ThirdStreetSouth

POBox727

Dassel,MN 55325-0727

OrderByFax:

Fill in theorder form

and fax toour toll-free

Fax:1-800-369-9207,

available24hours.

Orderonline:

www.cresthealthcare.com

Orderbyemail:

customerservice@cresthealthcare.com

Orderbyphone:

1-800-328-8908

Monday-Friday7:00a.m.until5:00p.m.

(CentralTime)

*Minimumordervalue is$25

Excluding shipping&handling.

*Minimum$25order

FacilityName

____________________________________________________

Customer#

___________________________________________________

Address

_______________________________________________________

City

___________________________

State

__________________________

ZipCode

_______________________________________________________

Name

___________________________________________________________

Dept.

____________________________________________________________

Phone

__________________________

Fax

__________________________

Email

___________________________________________________________

FacilityName

___________________________________________________

Address

________________________________________________________

City

___________________________

State

__________________________

ZipCode

______________________________________________________

Phone

_________________________

Fax

__________________________

C/O

_____________________________________________________________

___________________________________________________________________

__________________________________________________________________

___________________________________________________________________

PromotionCode#_______________________________

PurchaseOrder#________________________________

CreditCard#____________________________________

ExpirationDate__________________________________

CreditCardSecurityCode_________________________

Authorized

Signature_______________________________________

Date_____________MNTaxExempt#______________

BILLING INFORMATION

SHIPPING INFORMATION

FORCRESTUSEONLY:

UPSorFedExAccount#________________________________________________________________________________________

CHECK IFSAMEASBILLING INFO