Direct Purchase Order Form

Order Information

Please select the product you wish to order by checking on the box(es) below. Remember to include relevant information about your order, such as the number of boxes and your preferred method of shipment.

Product Item Number Price Quantity* Cost Shipping*
$ /
box of 10

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$ /
box of 10

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$ /
box of 5

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$ /
box of 5

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$ /
box of 5

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$ /
box of 5

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$ /
box of 5

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  • If you or your facility are a member of a Group Purchasing Organization (GPO), your price may be different. Please consult with your GPO for pricing and ordering information
  • Payment terms: Net 45 days.
  • Prices may change at any time.
  • Orders accepted M-F, 8:00 AM to 5:00 PM Central each Smith & Nephew business day.
  • All accepted orders ship F.O.B. origin, ground delivery freight included (ie, CPT shipping address, as defined in Incoterms 2010).
  • Orders must be received by 1:00 PM Central to ship same day.
  • By placing order, purchaser agrees to the accompanying
    terms & conditions.

Orders are accepted from the continental U.S. and Hawaii only. Products are filled and shipped by a contracted independent distributor. All payments are processed by Smith & Nephew on behalf of such distributor.




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