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About
- Careers
Technologies
Devices
Contact

Sterile Sample Request

- Step 1 of 2

`Sales Representative`

Name *First
Last

Date / Time
Date
Time

`Purchasing Contact`

Purchaser NAME *First
Last

Purchasing Phone Number

Purchasing Email

Surgeon Name *First
Last

Surgeon Phone

Surgeon Email

Current Customer?Yes
No

Est # Cases/MO

# Surgeons at Facility

`Ship to Address`

NAME of Receiver

Shipping AddressAddress Line 1
Address Line 2
City
State
Zip Code

`Final Destination`

Hospital / Facility Name

Final Destination ShippingSame as Shipping

AddressAddress Line 1
Address Line 2
City
State
Zip Code

Product Order InformationPosiSep®X .6 x 2.0 (5/box) | 9210584
PosiSep®X 8cm x 1.8cm  (5/box) | 9210604
PosiSep®X2 0.8 x 2.3 (5/box) | 9210615
PosiSep X .5 x 1.5 (5/box) | 9210564
PosiSep®C 0.6 x 2.0 (5/box) | 9210854
PosiSep®C 0.5 X 2.0 (5/box) | 9210754
PosiSep®C2 0.5 X 1.5 (5/box) | 9210764
PosiSep® 0.6 x 2.0 (5/box) | 9210574
PosiSep® 0.5 x 1.5 (5/box) | 9210554
NexPak® X 0.6 X 2.0 (5/box) | 9110531
NexFoam® 0.5 X 1.9 (5/box) | 9110254
BleedArrest®ER (5/box) | 9110274
NexStat® 3g Bellows (5/box) | 9130144
NexStat® 1g Bellows (5/box) | 9130154
Vectra® F Frontal (2/box) | 9210864

PosiSep .5 x 1.5 Box(es) *

PosiSep .6 x 2.0 Box(es) *

PosiSep X .5 x 1.5 Box(es) *

PosiSep X .6 x 2.0 Box(es) *

PosiSep®X 8cm x 1.8cm Box(es) *

PosiSep®X2 0.8 x 2.3 Box(es) *

PosiSep®C Box(es) *

PosiSep®C 0.6 x 2.0 Box(es) *

PosiSep®C2 Box(es) *

NexPak® X Box(es) *

NexStat® 3g Bellows Box(es) *

NexStat® 1g Bellows Box(es) *

NexFoam® Box(es) *

Vectra F Drug delivery micro-sponge Box(es) *

BleedArrest®ER Box(es) *

Shipment Method: Ground (3-5) days
3 Days
2 Days
Overnight
Priority Overnight

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Hemostasis, LLC

MedTech Center
5000 Township Parkway
Saint Paul, MN 55110 USA

Phone: 651-855-1466
Toll Free: 866-612-2568
Fax: 651-855-1465

customerservice@hemostasisllc.com
Terms and Conditions

Our Technologies

Accel® Absorbable Hemostatic Powder
BoneSeal® Bone Hemostat
BleedArrest® ER Foam Sponge
NexStat® Plus Topical Hemostat Powder
NexStat® Topical Hemostat Powder

NexPak® X Intranasal Splint
Vectra F^™ Drug Delivery Micro-sponge
PosiSep® C & C2
PosiSep® Hemostat Dressing/Intranasal Splint
PosiSep® X Hemostat Dressing/Intranasal Splint
NexFoam® Intranasal Splint

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