OR SURGICAL ROOM TURNOVER HARDWARE REQUEST

ACCOUNT EXECUTIVE INFORMATION

Ecolab AE First and Last Name *

Ecolab AE Email Address *

Do you need the Customer's Hardware Allowance Balance?

Yes, please provide balance

No, not at this time

CUSTOMER INFORMATION

Customer Account Name *

PO Number (If Required By Account)

Customer Account Number *

Customer Contact Name *

Customer Phone Number *

Number of ACTIVE Operating Rooms *

Customer Contact Email Address

SHIPPING INFORMATION

SHIP TO: *

HARDWARE ORDER IS SHIPPING TO: *

Ecolab Account Executive

Customer

Other Other

STREET ADDRESS *

SHIP TO ADDRESS PROVIDED IS: *

Residential

Business

ADDRESS LINE 2

PHONE NUMBER *

CITY: *

STATE *

ZIP CODE *

SPECIAL INSTRUCTIONS FOR CUSTOMER SERVICE:

0/255 characters

HARDWARE PRODUCTS

ECOLAB OR

Ecolab OR

	92021129 - Ecolab Small Cart - $585.99
	92022536 - Ecolab Sweep Set - $42.00
	92021118 - Ecolab Mop Frame with Straight Handle for Microfiber Mop - $27.30
	92022818 - Ecolab Mop Box - Red - $21.00
	92022798 - Ecolab Mop Box - Blue - $21.00
	92022808 - Ecolab Cart Mop Box Strainer Grey (for 92022818 & 92022798) - $21.00
	92021119 - Ecolab 5 Liter Measuring Bucket - Red - $18.00
	92022720 - Ecolab 5 Liter Cloth Bucket - Blue - $13.00
	92022784 - Ecolab 5 Liter Cloth Bucket Distribution Sieve (Grey) (for 92021119 & 92022720) - $9.00
	92022799 - Hooks for Carts - $7.49
	92022811 - Mop Clips - $4.04
	92022526 - Mop Head (Bottom part of Mop Stick) - $8.53
	92022723 - 5 Liter Yellow Measuring Bucket - $13.00
	92022802 - Grey Mop Tray Holder - $4.00
	50001035 - 32 Ounce HDPE Bottle - $.67
	50001036 - Flip Top Cap - $.65
	53002458 - 12 Pack Cylinder Bottle and Flip Top Cap - $8.00

BASIC OPERATING ROOM SET-UP

Basic Operating Room Set-Up

	315325S - Gel Positioner Set, 1 Head & 2 Armboard - $274.73
	9200MFB - Mop Bucket with Wheels - $72.00
	9200MFE - Extendable Mop Stick - $32.00
	9200MFS - Ecolab Mop Frame with Z-Shaped Handle for Microfiber Mop - $28.22
	AMD2212-SQ - Receptacle, Square Sponge Collecting - $486.85
	DM-MS-01 - Mop Stick, Lock Jaw Style - $27.30
	DM-SC-01GLD - Storage Container, 32 Gal, Gray with Lid and Dolly - $215.73
	DM-SC-01WLD - Storage Container, 32 Gal, White with Lid and Dolly - $209.65
	HSPL-04 - Hamper Stand with Foot Pedal Assembled, Plastic Lid - $199.23

SPECIAL ORDER PRODUCTS (4-8 WEEK LEAD TIME)

HEAD POSITIONERS

Head Positioners

	BD2160 - Pediatric Head Donut Pad - Medium - 6" X 2" X 1 1/4" - $84.76
	40202 - Pediatric Head Donut Pad - 5 1/2" X 3" X 1 3/4" - $133.38
	40202D - Pediatric Donut Head Pad With Centering Dish - 5 1/2" X 3" X 1 3/4" - $133.38
	40205 - Pediatric Horseshoe Head Pad - 5 1/2" X 2 1/4" X 1 1/4" - $133.38
	BD2150 - Adult Donut Head Pad - 8" X 3" X 2 1/4" - $97.60
	BD2175 - Pediatric Horseshoe Head Pad - Medium - 5 1/2" X 2 1/4" X 1 1/4" - $84.76
	40201 - Adult Donut Head Pad - 8" X 3" X 1 3/4" - $166.14
	40212 - Adult Donut Head Pad - 8" X 3" X 3" - $255.06
	40201D - Adult Donut Head Pad with Centering Dish - 8" X 3" X 1 3/4" - $166.14
	BD2170 - Adult Horseshoe Head Pad - 8" X 3" X 2 1/4" - $92.95
	40204 - Adult Horseshoe Head Pad - 8" X 3" X 1 3/4" - $165.47
	BD2220 - Prone Headrest With Tube Channels - 8" X 3 1/2" X 1 1/4"- $292.50
	40216M - Prone Headrest - Medium - 8 3/4" X 7 3/4" X 4 3/4" - $372.06
	40216L - Prone Headrest - Large - 10 5/8" X 9" X 5 1/4" - $456.30
	BD2180 - Pillow With Centering Dish - 9" X 10" X 1" - $76.65
	BD2185 - Pillow With Centering Dish - 9" X 10" X 2" - $115.80
	40207 - Pillow With Centering Dish - 9" X 10" X 1" - $63.00
	40213 - Contoured Head Pad - 7" X 7" X 3 1/4" - $262.08

ARMBOARDS, GELS, NERVE PROTECTORS & TOBOGGAN PAD

Rounded End Armboards

	BD2235 - Extra Wide Armboard Round End - 26" X 6" X 1/4" - $124.80
	BD2235-58 - Full Size Armboard Round End - 26" X 6" X 5/8" - $176.93

Square End Armboards

	BD2230 - Small Armboard Pad - 15" X 6" X 1/4" - $49.82
	BD2240 - Large Armboard Pad - 24" X 4 1/2" X 3/8" - $86.01
	40309 - Wide Small Armboard Pad - 15" X 6 1/2" X 1/4" - $91.26
	40308 - Wide Long Armboard Pad - 24" X 6 1/2" X 3/8" - $180.18
	40301 - Long Armboard - 24" X 4 1/2" X 3/8" - $120.41

Contoured Armboards

	BD2010 - 2” Contoured Gel/Foam Armboard - 26" X 6" X 2" - $350.58
	BD2010-3 - 3" Contoured Gel/Foam Armboard - 26" X 6" X 3" - $465.27
	40307 - Small Contoured Armboard Pad - 16" X 5 1/2" X 2" - $306.80
	40310 - Medium Contoured Armboard Pad - 20" X 5 3/4" X 2 1/4" - $339.30
	40306 - Large Contoured Armboard Pad - 24" X 5 3/4" X 2 1/4" - $376.74

Ulnar Gels

	BD2260 - Full Ulnar Nerve Protector - 17" X 12" X 1/4"- $95.16
	40303 - Ulnar Forearm Protector - 18" X 13" X 1/4" - $138.06

Ulnar Nerve Protectors

	BD2270 - Oval Ulnar Nerve Protector - 13" X 6" X 1/4" - $95.16
	40304 - Small Ulnar Nerve Protector - 15 3/4" X 6" x 1/2" - $138.06
	40304L - Large Ulnar Nerve Protector - 19" X 8 1/2" X 4 1/2" - $156.78

Toboggan Pad

40130 - Toboggan Pad - 16 1/4" X 8 1/4" X 3/8"- $133.38

GEL POSITIONERS

Gel Positioners

	BD2490 - Small Pedicatric Flat Positioner - 6" X 2 1/2" X 2" - $59.49
	40639 - Small Pediatric Flat Positioner - 6" X 2" - $81.90
	40640 - Flat Bottom Positioner - 8" X 2" - $65.20
	40641 - Flat Bottom Positioner - 10" X 2" - $74.10
	BD2410 - Small Flat Bottom Positioner -13" X 5" X 4" - $127.92
	40616 - Small Flat Bottom Positioner - 12" X 4" - $194.22
	BD2440 - Small Flat Bottom Positioner - 12" X 7" X 6" - $321.75
	BD2420 - Medium Flat Bottom Positioner - 16" X 4 1/2" X 4" - $179.92
	40620 - Medium Flat Bottom Positioner - 16" X 6" - $599.04
	BD2450 - Medium Flat Bottom Positioner - 16" X 7" X 6" - $433.16
	40618 - Large Flat Bottom Positioner - 20" X 4" - $320.58
	BD2430 - Large Flat Bottom Positioner - 20" X 4 1/2" X 4" - $233.48
	BD2460 - Large Flat Bottom Positioner - 21" X 7" X 6" - $536.20
	40619 - Small Flat Bottom Positioner - 12" X 6" - $444.60
	40621 - Large Flat Bottom Positioner - 20" X 6" - $755.82
	BD2360 - Small Gel Filled Positioner - 10" X 5" X 2 1/4" - $87.96
	40602 - Small Gel Filled Positioner - 10" X 4 1/2" X 2" - $126.36
	BD2370 - Large Gel Filled Positioner - 14" X 5" X 2 1/4" - $98.36
	40605 - Large Gel Filled Positioner - 14" X 4 1/2" X 2" - $149.76
	40615 - Extra Large Gel Filled Positioner - 18" X 4" X 2" - $177.84
	BD-BB3040 - Bean Bag with Shoulder Cut Out - 40" X 30" - $609.70
	BD-BB3040-G - Bean Bag with Integral Gel and Shoulder Cut Out - 40" X 30" - $1,218.10
	BD2380 - Sloped Thoracic Positioner - 16" X 10 1/2" X 2" - $229.84
	40604 - Graduated Thoracic Positioner - 14" X 9" X 2" - $338.00

HEEL PADS

Heel Pads

	BD2290 - Clamshell Heel / Elbow Protector - 12 1/2" X 7 3/4" X 1/2" - $83.85
	BD2295 - Heel Elevators (Pair) - 6" X 2" - $192.40
	40401 - Heel Protector Pad - 12 1/2" X 7 3/4" X 1/2" - $117.00
	BD2330 - Candy Cane Tubular Post Gel Stirrup Pad - (pair) 24" Long Cylinder - $165.00
	BD2335 - Ankle Stirrup Strap Set (Pair) - 12" X 1" X 1/2" - $124.33
	40510 - Ankle Stirrup Set Small - 12 1/2" X 1 7/8" X 3/8" - $142.74
	40502 - Heel Support Gel With Cup Cutout - 6" X 3 1/4" X 1 3/4" - $89.00
	BD2280 - Foot/Heel/Sole Protector - 15" X 6" X 1/4" - $65.00

TABLE PADS

Table Pads

	BD2570 - Fracture Table Hip Pad - 7" X 5" X 1/2" - $49.40
	BD2130-1 - Square Table Pad - 20" X 9" X 1/2" - $106.60
	40104-A - Table Pad - 20" X 9" X 1/2" - $154.44
	BD2140 - Table / Hip Pad - 20" X 20" X 1/4" - $237.25
	BD2140-25 - Square Hip / Foot Pad - 20" X 20" X 1/4" - $111.41
	40105 - Small Table Pad - 20" X 20" X 1/2" - $327.60
	BD2100 - 3/4 Table Pad - 46" X 20" X 1/2" - $735.70
	40100 - 3/4 Table Pad - 46" X 20" X 1/2" - $1,003.86
	BD2110-25 - Full Table Pad Light Weight - 72" X 20" X 1/4" - $545.35
	BD2110 - Full Table Pad - 72" X 20" X 1/2" - $744.12
	40101 - Full Table Pad - 72" X 20" X 1/2" - $1,106.82
	BD2135 - 3 Piece Table Pad with Square Foot Pad - NA - $785.20
	BD2130 - 3 Piece Gel or Overlay with 2 Cut Outs - NA - $767.00
	40104 - 3 Piece Gel or Overlay with Cut Out - NA - $1,106.82
	BD2130-3 - Foot Section with Cut Out - 20" X 20" X 1/2" - $218.40
	40104-B - Torso with Perennial Cut Out - 39 1/2" X 20" X 1/2" - $641.16
	40104-C - Foot Section with Perennial Cut Out - 20" X 20" X 1/2" - $339.30
	BD2130-2 - 3/4 Full Table Pad with Cut Out - 40" X 20" X 1/2" - $454.87
	BD2120 - 3/4 Full Table Pad with Cut Out - 46" X 20" X 1/2" - $735.70
	40103 - 3/4 Full Table Pad with Cut Out - 46" X 20" X 1/2" - $1,003.86
	BD2580 - Fracture Table Post Pad - 5" X 7" X 1/2" - $109.20
	BD2300 - Small Blue Knee Crutch Pad - 9" X 11" X 3/8" - $57.47
	BD2310 - Blue Knee Crutch Pad - 11" X 17" X 1/4" - $72.27
	BD2320 - Large Blue Knee Crutch Pad - 20" X 20" X 1/2" - $257.20
	BD2640 - Wheelchair Gel Pad - 16" X 16" X 5/8" - $162.62

MISCELLANEOUS

Miscellaneous

	BD2300 - Small Blue Knee Crutch Pad - 9" X 11" X 3/8" - $57.47
	BD2310 - Blue Knee Crutch Pad - 11" X 17" X 1/4" - $72.27
	BD2320 - Large Blue Knee Crutch Pad - 20" X 20" X 1/2" - $257.20
	BD2640 - Wheelchair Gel Pad - 16" X 16" X 5/8" - $162.62
	91262 - Molded Plastic Replacement Lid for Hamper - $20.00

ORDER TOTAL 🛈

$0.00