|
|
| Facility Name |
|
| Your Name |
|
| Address |
|
|
|
| City, State, Zip |
|
| Phone |
- ext |
| E-Mail |
|
|
|
Please select two sample choices from the list below: |
|
Baxter Device |
New AIV Part |
AIV Part Number |
|
FloGard 6201 |
Front Cover Case |
BX10610 |
|
FloGard 6201 |
Rear Cover Case |
BX10938 |
|
FloGard 6201 |
Label Sheet, Rear Case |
BX11073 |
|
FloGard 6201 |
Key Pad Overlay |
HPNL1025A |
|
FloGard 6301 |
Front Cover Case |
BX10726 |
|
FloGard 6301 |
Rear Cover Case |
BX10939 |
|
FloGard 6301 |
Label Sheet, Rear Case |
BX11074 |
|
FloGard 6301 |
Key Pad Overlay |
HPNL1026A |
|
FloGard 6301
|
Pump Head Door Assembly, P1- left
|
BX10469
|
|
FloGard 6201/6301 |
Pump Head Door Assembly, P2- right |
BX10468 |
|
FloGard 6201/6301 |
Door Latch Assembly (P2-right) |
BX10675 |
|
FloGard 6301 |
Door Latch Assemly (P1-left) |
BX10676 |
|
FloGard 6201/6301 |
Power Cord |
PCM8 |
|
Colleague |
Power Cord |
PC10761 |
|
Colleague |
Front Bezel |
BX11797 |
|
Colleague |
Front Bezel, Color |
BX11954 |
|
Colleague |
Main Housing |
BX10933 |
|
Colleague |
Rear Housing |
BX10888 |
|
Colleague |
Pump Mechanism Housing |
BX10887 |
|
Colleague |
C1 Keypad |
BX10890 |
|
Colleague |
C3 Keypad |
BX10891 |
|
Please note: If more than two samples are selected, only the first two choices will be processed. |
|
How did you hear about AIV's Pick Two Baxter Pump Parts Sample Program? |
|
|
|
|
The manufacturers listed are the holders of their respective names and/or trademarks, and are not to be taken as endorsement or affiliation with AIV, Inc. |
