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GLEE BIOTECH LIMITED
ORDER FORM SPECIALLY FOR PPE KIT HIV/HEPATITIS/COVID-19
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Email
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Your email
1
2
3
4
5
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EMAIL ID
CONTACT NO.
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Your answer
ORDER PLACED BY
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COMPANY/FIRM/ORGANISATION
HOSPITAL/INSTITUTE
INDIVIDUAL
ADDRESS OF INDIVIDUAL/COMPANY/HOSPITAL
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Your answer
SIZE
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S
M
L
XL
XXL
QUANTITY IN PIECES
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Your answer
SELECT COMPONENTS
(AS PER YOUR REQUIREMENT)
COVERALL SUIT/GOWN
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COVERALL SUIT WITH INTEGRATED HOOD & SHOE COVER
COVERALL SUIT WITH INTEGRATED HOOD
COVERALL GOWN
HEAD GEAR
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YES
NO
BOUFFANT CAP
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YES
No
FACE MASK
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3-PLY MASK WITH NOSE PIN AND FILTER
N-95 MASK WITH EXHALATION VALVE
N-95 MASK WITHOUT EXHALATION VALVE
SAFETY GOGGLES
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Yes
No
FACE SHIELD
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YES
NO
APRON
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YES
No
GLOVES(A PAIR)
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EXAMINATION GLOVES
NITRILE GLOVES
STERILE SURGICAL GLOVES
SHOE COVER (A PAIR)
*
SHOE COVER WITH KNEE LENGTH
BIO HAZARD BAG
*
YES
No
BILLING ADDRESS
Your answer
DELIVERY AT
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Note:
ALL PICTURES ARE SHOWN HERE FOR ILLUSTRATION PURPOSE ONLY.ACTUAL PRODUCT MAY VARY DUE TO PRODUCT ENHANCEMENT.
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