N-TERFACE® Wound Contact Layer Order Form Please use the form below to order wound care products. Facility/ Company Name(Required) Purchase Order #(Required) Contact PersonName(Required) First Last Phone(Required)Email(Required) Shipping AddressAttention To(Required) Address Street Address Address Line 2 City State Zip Code Click here to use Shipping Info as Billing Info: Billing AddressCompany Name Address Street Address Address Line 2 City State Zip Code Select Products:N-TERFACE® Material 4480-04 BX (4" x 4" BOX/25) 4480-04 CS (4" x 4" CASE/100) 4480-12 BX (4" x 12" BOX/12) 4480-12 CS (4" x 12" CASE/48) 3810-144 BX (12" x 12" BOX/12) 3810-144 CS (12" x 12" CASE/48) 3810-288 BX (12" x 24" BOX/12) 3810-288 CS (12" x 24" CASE/48) 4120-48RL BX (4" x 10' ROLL BOX/6) 4120-48RL CS (4" x 10' ROLL CASE/24) Notes/Comments