Shipping Request

ITEM DESCRIPTION

Items to ship*

Intracel
Intragen
Edge
Smoothcool
Tribeam
Lipocel
other

Please Upload the Sales Order if possible

Accepted file types: jpg, png, pdf, gif, Max. file size: 5 MB.

Serial Number

Description (i.e. model or product)*

Lipocel requires a 220VAC regulator

Ship a 220VAC regulator

240 VAC plug requirement (Smoothcool and Tribeam)*

240 VAC systems ship with L6-30 as a default.

Special Instructions (list anything extra shipping with a system)

SHIP TO

Where is it being delivered?*

Delivery address (if Other specified)

Business or Contact Name

Phone at delivery address

Email at delivery address

SHIP FROM

Where is it being picked up? (ignore for new products)

Other pick up address and phone number

Perferred Shipper

let MRP decide
Fedex
UPS

Size: length x width x height (ignore for new products)

Specify the size if this is not a standard package or system crate.

Approximate Weight (ignore for new products)

Specify the weight if this is not a standard package or system.

BILLING INSTRUCTIONS

Who is paying for the shipping?*

SHIPPING INSTRUCTIONS

Who is arranging shipping?

When does it have to be there?

Please allow 5 days depending on weather. East coast deliveries may take up to 7 days. Faster deliveries require an expediting fee.

When do you want it picked up?

For ASAP use today's date. It will be scheduled as soon as possible.

Shipping checklist (check all that apply)

Requester is expected to handle all logistics and be responsible for crate unless specified otherwise. If this is a system sale then marketing collateral will be included.

Shipper to unpack
This is a sale to a customer
Shipper to contact me before delivery
May be subjected to freezing weather
I will take care of crate and pack/unpack
Crate to be returned
Shipper to wait for exchange and return
Request return label (i.e. exchange parts)

EXTRA ITEMS

Select the type of Marketing Kit ordered with the sale

If this is a sale to a customer please check the correct kit they need for office marketing.

Customer logo or photo for brochures

Upload the logo or customer photo they want on their patient brochures and collateral.

Max. file size: 2 GB.

Contact Information for Patient Brochures

List the business name and contact information : address, phone, email, website that the customer wants listed.

Hidden

Delivery Address

Perigee, 899 Arguello St, Unit C, Redwood City, CA 94063
Perigee, 50 Woodside Plaza, #108, Redwood City, CA 94061
Perigee, 10183 N Aero Dr, Ste 7 Hayden, ID 83835
Perigee, Manteca, CA
Dale Koop
Other address

Hidden

Pick up address

Perigee Redwood City
Perigee Idaho
To be determined by Perigee

Submitted by*

Your Name

Phone (required if you want shipper to contact you)

Your Phone (required if you want shipper to contact you)

Email

Your Email

Post Custom Field

File

Max. file size: 2 GB.