Product Quote Form
Name:
Organization:
Phone:
Fax:
E-Mail:
Address:
City:
State/Zip:
Quantity
LOTS
®
ComposiTrac
®
Splint
- CTS-36
LOTS
®
Pelvic Compression Device
™
- PCD-48
LOTS
®
Trauma Splint
- LTS-36 / NO
PCD-48
LOTS
®
Trauma Pak
- LTP-680 / NO
PCD-48
LOTS
®
Health Care Medic
™
- HCM-36
LOTS
®
Health Care Professional
™
-
HCP-680
LOTS
®
Tactical Care Medic
™
- TCM-36
LOTS
®
Tactical Care Professional
™
-
TCP-680
LOTS
®
Tac Med Operator
®
-
TMO-36
Tactical TMO-36
/ Black Case 802
Military
TMO-36 /
Foliage Green Case 580
LOTS
®
Tactical Combat Care Medic
™
- TCCM-36
LOTS
®
Tactical Combat Care Professional
™
- TCCP-680
LOTS
®
PneumoVac
®
- PVS-36
LOTS
®
PneumoVac
®
- PVS-680
Type of Service:
Please Select One ---->
Ambulance
Fire/Rescue
LE/SWAT
Military
Other
Order Part/
Component
: Make/Model or Description
Optional Description or Comments Field: