Humankind Durham Pharmacy Order Form

Minimum order value is £100.00 (exc VAT).Orders placed before 1pm will qualify for next day delivery.

Please note, the submit button will appear at the bottom of the form once the minimum order value is reached.

Name of Pharmacy

Address

Post Code

Contact Name

Telephone

Email Address

Product Code

Description

Box Qty

Qty Boxes

OMP190

1ml Red Pack

OMP191

2ml Orange Pack

OMP194

2ml Blue Pack

OMP196

2ml BlackPack

OMP907

1ml Single Kit - 29g

350

OMP939

2ml Single Kit (Orange Needle)

260

OMP945

2ml Single Kit (Blue Needle)

260

OMP936

2ml Single Kit (Black Needle)

260

OMN035

SAFELOC™ 0.35 ltr NX Container

OMAPY25

SAFELOC™ 25 ltr Sharps Bin

OMAPY65

SAFELOC™ 60 ltr Sharps Bin

Please tick to confirm you have ordered sufficient 25ltr and 60 ltr sealed units for your needle exchange waste

Yes

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