Packs Order Form — Capitol Express, LTD.

Please use this form as a preliminary pack order form. Our team will contact you to organize the details of your pack order.

Name

First Name

Last Name

Company

Country

Email

Office Phone

Country

(###)

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Mobile Phone

Country

(###)

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Pack contents

We have over 200 items in stock, ranging from drapes to syringes to speculums. Just tell us what you would like in your pack, and we will be in touch to organize the specifics.

Notes