Health Management Systems, Corp.

888-300-4672         

We offer the highest quality products for Point-of Care Testing!

 

  Reserve Loaner LDX Units
  

Please fill out the following form if you would like to reserve LDX Units for your next event.  LDX's may be reserved up to 90 days in advance.

NOTE:  This does not constitute an order!!!  You will need to place an order for the LDX Units, Cassettes, & other supplies prior to your event.

USE THE TAB OR MOUSE, NOT THE ENTER KEY, TO MOVE BETWEEN FIELDS.  The enter key will submit the form.  If you hit the enter key prior to completion of the form, use your back button and continue filling out the form.  Click submit or Enter when done.

Company Name:

Contact Name:

Phone Number:

Fax Number:

Email Address:


For Identification purposes please enter one of the following:

 Event Name / Program Name / Client Name / P.O. # / Shipping Location

Number of LDX's requested:

Requested Ship Date: (Date you would like the LDX's shipped from Plano, TX to your location)

Arrival Date: (Latest date the equipment can arrive at your location)

First Event Date:

Last Event Date:

Return Ship Date: (Date you will be shipping the LDX's back to us)


If you have any questions or problems with this site, please call Health Management Systems, Corp. customer service at 888-300-4672