How to Order NMP22® BladderChek® Test

In the United States, if you are a licensed physician you may order the NMP22® BladderChek® Test by simply filling out the form below.

Billing Information

Order Date:
Order Purchase #:
Office Name:
Physician Ordering Test:
Billing/Office Manager:
Address:
Address:
City:
State
Zip Code:
Phone:*
FAX:*
Regional Sales Manager:
Email:*
	* NOTE: Phone # AND either FAX or email address required for order confirmation and shipping


Shipping Information

Office Name:
Attn:
Address:
Address:
City:
State:
Zip Code:
Phone:*
FAX:*
Email:*

Product Information
	Units*	Item#	Description	Unit Price	Total
		D1200	NMP22 BladderChek Test- Box of 24 Tests	$628.80	$
		D1250	NMP22 BladderChek Test- Control Kit	$58.00	$
				Subtotal	$

	Please Note: This order form is for United States doctors only. This form does not include sales tax. You will be contacted by a Matritech representative to determine your cost of shipping and sales tax. Returns Buyer may not return product. If, however, any Product fails to perform in accordance with the labeling provided by Matritech as documented by an examination of the Product pursuant to a formal complaint handling procedure established in accordance with standard industry practices, Buyer may return such defective Product upon obtaining an authorization from Technical Services. This authorization shall include an Authorization Number which must be affixed to any product returned. Shipping FOB Matritech Net 30 days For more information please contact us at: 800-320-2521 ext.1 or email: nmp22@matritech.com