Armour

Name *

Company Name *

North Coast Account #

Title *

Email *

Phone *

Do you see an advantage of using a thermoplastic that is twice as strong as your current product? *

YesNo

Which brand of thermoplastics do you most prominently use? *

PolyFlex IITailer SplintEzeFormPreferred®Vanilla®Solaris®Other

Which configuration do you prefer to purchase thermoplastics? *

Single SheetsCase of 4 SheetsPre-CutsCustom Pre-CutsReady-Sheets™Other

Other Distributor

Other Thermoplastic Brand

Other Configuration

Mailing Address *

Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry

Samples are intended for healthcare professionals only.