Qualilab QL-Elite Configuration Sheet

QualiLab QL-Elite order form

For the QL-EZ order form, click this link.
Purchase Order Date
MM slash DD slash YYYY
Completed By*
Completed By
First Last
PO Number*
Buyer Company*
End User Company
Country*
Please configure the main unit only. All additional modules need to show on the purchase order.
Syringe add-on with 2 syringes can be ordered separately.
QualiLab Model*
Number of syringes*
- 0
- 2
Added syringe module for a total of 4 syringes.
Syringe 1 size
Syringe 2 size
Syringe 3 size
Syringe 4 size
Head assembly, exchangeable
- TQL7445 Head assembly, exchangeable, CVS, with adapters
- TQL7442 Head assembly, exchangeable, titro
ChemPacks required?
- Yes
- No
If YES, please attach Form 436 to PO. If TF number is known, it must be itemized on the PO.
Options
- R001981 - OCBSA Feature
- R001982 - Program MPVS
- R001984 - R&D including MPVS
(To be itemized on Purchase Order)
Additional Requirements
CAPTCHA
Name
This field is for validation purposes and should be left unchanged.

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