Packaging Material Order Form

1. Select your desired product by clicking on the box to the left of the product number
2. Enter the case quantity desired on the right side of the product description
3. Select “submit” at the bottom of the page to send your order

Fill Out The Below Information

PO#:

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Facility Name:

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Contact Name:

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Email:

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Phone:

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Auto-Print™ ‐ 1.5" Materials:
Oral Solid Machine

	4001N Auto-Print SUPERTHERM™, 1.5"- 5,400LFT (6x900')	QTY:
	9704 Auto-Print SUPERCEL™, 1.5" Clear - 10,800LFT (6x1800')	QTY:
	9705A Auto-Print SUPERCEL™, 1.5" Amber - 10,800LFT (6x1800')	QTY:
	9705R Auto-Print SUPERCEL™, 1.5" Red - 10,800LFT (6x1800')	QTY:

Auto-Print™ ‐ 2.0" Materials:
Oral Solid Machine

	4002N Auto-Print SUPERTHERM™, 2.0"- 5,400LFT (6x900')	QTY:
	1004 Auto-Print SUPERCEL™, 2.0" Clear - 10,800LFT (6x1800')	QTY:
	1005A Auto-Print SUPERCEL™, 2.0" Amber - 10,800LFT (6x1800')	QTY:
	1005B Auto-Print SUPERCEL™, 2.0" Blue - 10,800LFT (6x1800')	QTY:
	1005C-1 Auto-Print SUPERCEL™, 2.0" Rainbow - 10,800LFT (6x1800')	QTY:
	1005L Auto-Print SUPERCEL™, 2.0" Light Green - 10,800LFT (6x1800')	QTY:
	1005O Auto-Print SUPERCEL™, 2.0" Orange - 10,800LFT (6x1800')	QTY:
	1005P Auto-Print SUPERCEL™, 2.0" Purple - 10,800LFT (6x1800')	QTY:
	1005R Auto-Print SUPERCEL™, 2.0" Red - 10,800LFT (6x1800')	QTY:
	UDB252 Box, Unit Dose, 30 Day, 2.0"x 5.0" ‐ 1,000	QTY:

Fluidose -
Liquid Machine

	5001M Fluidose-LIDDING™, 2.125"- 4000LFT (4x1000') - Matte Finish	QTY:
	5002A Fluidose-UDCUP™, Small, 15mL Amber - 2000 (50x40)	QTY:
	5002BN Fluidose-UDCUP™, Small, 15mL Blue - 2000 (50x40)	QTY:
	5002RDN Fluidose-UDCUP™, Small, 15mL Red - 2000 (50x40)	QTY:
	5002Y Fluidose-UDCUP™, Small, 15mL Yellow - 2000 (50x40)	QTY:
	5003A Fluidose-UDCUP™, Medium, 25mL Amber - 2000 (50x40)	QTY:
	5003BN Fluidose-UDCUP™, Medium, 25mL Blue - 2000 (50x40)	QTY:
	5003RDN Fluidose-UDCUP™, Medium, 25mL Red - 2000 (50x40)	QTY:
	5003Y Fluidose-UDCUP™, Medium, 25mL Yellow - 2000 (50x40)	QTY:
	5007A Fluidose-UDCUP™, Large, 35mL Amber - 2000 (100x20)	QTY:
	5007BN Fluidose-UDCUP™, Large, 35mL Blue - 2000 (100x20)	QTY:
	5007RDN Fluidose-UDCUP™, Large, 35mL Red - 2000 (100x20)	QTY:
	5007Y Fluidose-UDCUP™, Large, 35mL Yellow - 2000 (100x20)	QTY:
	5005 Fluidose-TUBING™, Baxa, Regular - 10	QTY:
	5006 Fluidose-TUBING™, Baxa, Large - 10	QTY:
	5501 Fluidose-TUBING™, Syringe, Large - 10	QTY:
	5502 Fluidose-TUBING™, Syringe, Small - 10	QTY:
	5511 [S/N > 659] Fluidose-TUBING™, Syringe (Pinch Valve), Large - 10	QTY:
	5512 [S/N > 659] Fluidose-TUBING™, Syringe, (Pinch Valve), Small - 10	QTY:
	5513 [S/N > 659] Fluidose-TUBING™, Syringe (Pinch Valve), Extra-Large - 10	QTY:
	5510 Syringe - 10mL Luer-LokTM tip - 100	QTY:
	5520 Syringe - 20mL Luer-LokTM tip - 48	QTY:
	5530 Syringe - 30mL Luer-LokTM tip - 56	QTY:
	T002P Ribbon, Trnfr FD 2.09" - 7,080LFT (6x1080)	QTY:

PALP Accessories

	DTLP-L1, Label, DT 1.0" x 3.0'' - 4,125 (3x1375)	QTY:
	DTLP-L2, Label, DT 0.5" x 3.0'' - 7,200 (3x2400)	QTY:
	DTLP-L3, Label, DT 0.25'' x 1.0" - 10,000 (4x2500)	QTY:
	DTLP-L4, Label, DT 0.5'' x 1.5'' - 8,250 (3x2750)	QTY:
	DTLP-L5, Label, DT 0.25"x 1.25'' - 10,000 (4x2500)	QTY:
	DTLP-C1, Label, DT, Circle 1''x 1" - 3,000 (3x1000)	QTY:
	DTFLAG-1N, Label, Flag, DT, White - 3,000 (3x1000)	QTY:
	DTFLAG-1O, Label, Flag, DT, Orange - 3,000 (3x1000)	QTY:
	DTFLAG-1R, Label, Flag, DT, Red - 3,000 (3x1000)	QTY:
	DTFLAG-1Y, Label, Flag, DT, Yellow - 3,000 (3x1000)	QTY:
	TTFLAG-1N, Label, Flag, Clear Stem Fold-3,000+TT Rbn	QTY:
	TTFLAG-4, Label, Flag, Clear Stem Strght-3,000+ TT Rbn	QTY:
	TTLP-TR104, Ribbon, Trnfr PALP 4.3" - 2,913" (x1)	QTY:

Bags - Bagging System

	SPB-B1 Bags, 2.0" x 4.0" White - 9,000 (3x3000)	QTY:
	SPB-B1A Bags, 2.0"x 4.0" Amber ‐ 9,000 (3x3000)	QTY:
	SPB-B2 Bags, 3.0''x 4.0'' White - 9,000 (3x3000)	QTY:
	SPB-B3 Bags, 5.0"x 5.0" White - 6,750 (3x2250)	QTY:
	SPB-B4 Bags, 3.0"x 8.0" White - 4,500 (3x1500)	QTY:
	SPB-B5 Bags, 2.0"x 7.0" White - 5,250 (3x1750)	QTY:
	APB-B7A Bags, 4.0"x 14.0" Amber ‐ 3,000 (3x1000)	QTY:
	APB-T3 Ribbon, Trnfr APB 6.5" - 3,543LFT (3x1181) - Standard-APBS	QTY:

Office Information

Southern Medical Systems, Inc.

831 Coventry Street
Boca Raton, FL 33487

Tele: 561.432.0508
Fax: 561.433.0301

Email SMS at: info@southernmedicalinc.com

Southern Medical Systems services MPI customers in Florida and Georgia. Other territories please contact your local rep or Medical Packaging to order disposable materials.

Tele: 561.432.0508 | Fax: 561.433.0301 | Email: info@southernmedicalinc.com
Address: 831 Coventry Street, Boca Raton, FL 33487

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