POCT Single kits – Order form

POCT ORDER FORM FOR SINGLE KITS OF THE QUALITY CONTROL KIT(S) COAGUCHECK (any type)
Product code: ECAT11001

To order the INR QC kits please use this online order form.

You will receive a confirmation by e-mail.
If you need any assistance, please contact us at info@ecat.nl.

Order form ECAT INR Quality Control (QC) kit(s) (Product code: ECAT 11001)

This is the order form for ECAT INR QC kits for the Coaguchek (any type) * mandatory field

Order

Product code: ECAT11001
Number of QC kits you want to order *

Contact details

Institution *
Department
Name contact person *
Address *
Postal code *
City *
Country *
E-mail contact person *
Phone contact person *

Delivery address (optional)

Institution
Department
Address
Postal code
City
Country

Confirmation

Terms of delivery *
Hereby I confirm that I agree with the Terms of delivery of the ECAT Foundation
Name contact person invoice *
E-mail Financial Department (used for invoice) *
VAT Number (if available)
Your order number (optional)
If you have other questions/remarks, please let us know
Copy of this order form: A copy of this order form will be sent to the e-mail address of the contact person.

Verification

Please enter any two digits *Example: 12
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