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Capsa Solutions LLC                                                                      Created by Heidi Scarberry
  4800 Hilton Corporate Dr                                                                 Customer # C003307
  Columbus OH 43232                                                                        Salesperson
                                                                                       Expiration Date 8/12/2011
  Sold To: ASIAN MEDICAL DISTRIBUTORS Ship To:        ASIAN MEDICAL DISTRIBUTORS           Quote Rev 0
             INC                                      INC
            1589 MAYHALIGUE ST.                       1589 MAYHALIGUE ST.
             SANTA CRUZ                               SANTA CRUZ
             MANILA 1003                              MANILA 1003
             PHILIPPINES                              PHILIPPINES
Quote Number            Quote Date     Requested By    Email Address           Phone Number                   Fax
E000000142                7/13/2011
  Line     Item Number / Description                  UM     Quantity     Unit Price      Discount %       Extended Price
      1    19203                                      EA       1.000       1,771.35           40.00              1,062.81
           MDSE DELUXE CART (NC)

     2     19004                                      EA        2.000         80.01           40.00                  96.01
           MDS 3" DELUXE DWR. W/DIV. WALLS

     3     8200                                       EA        6.000        100.07           40.00                 360.25
           TTC CASSETTE W/4.5" BINS

     4     8211                                       EA        6.000          0.00                                     0.00
           TTC LOCK SYSTEM

     5     8184-GT                                    EA       36.000          0.42           40.00                     9.07
           TTC BIN DIVIDER 4.5"-GT

     6     19091                                      EA        2.000         92.03           40.00                 110.44
           MDS 6" DELUXE DWR. W/DIV. WALLS

     7     10386B                                     EA        1.000         74.29           40.00                  44.57
           WASTE STORAGE CONTAINER-COMPLETE

     8     10392E                                     EA        1.000         90.67           40.00                  54.40
           WRITING SURFACE EXT.-GRAY TAUPE

     9     P7048-1                                    EA        1.000         65.36           40.00                  39.22
           KENDALL SHARPS CASE W/SAMPLE, NO LADDER

    10     P7049B                                     EA        1.000         41.11           40.00                  24.67
           KENDALL GLOVE BX AND MNT, NO LADDER

    11     BRAKE                                      EA        1.000         11.76           40.00                     7.06
           ADDITIONAL BRAKING CASTER UPCHARGE

    12     9564B                                      EA        1.000         85.94           40.00                  51.56
           I.V. POLE-COMPLETE FOR X-90

    13     10219                                      ST        4.000         20.74           40.00                  49.78
           MDS DRAWER DIV. SET-GRAY TAUPE

    14     8078                                       EA       36.000          0.95           40.00                  20.52
           HOSPITAL BIN NAME TAG HLDR-4.5




   Page 1 of 2
Line     Item Number / Description                                                 UM           Quantity       Unit Price        Discount %         Extended Price
  15      10180-SD-C                                                               EA             1.000              0.00                                     0.00
         TOP CAP, SMALL-SAND-COMPLETE

  16      10434                                                                    EA
                                                                                                   2.000            0.00                                         0.00
         TOP CAP CORNER BUMPER

  17     9420                                                                      EA
         CORE, REMOVABLE                                                                           2.000           34.28                                        68.56




Terms:         By signing Quote Acceptance, the customer agrees to the price and accuracy of the quote, and                   Sales Total                   1,998.92
               accepts all terms and conditions as outlined within the attached terms document. Domestic
                                                                                                                            Misc Charges                        0.00
               shipments: FOB Factory; International shipments: EX-Works Factory, freight quote subject to
                                                                                                                               Sales Tax                        0.00
               change based on destination, fuel surcharges, force majeure or guaranteed delivery window of
                                                                                                                            Invoice Total                   1,998.92
               expedited route. Special Delivery needed must be noted at time of quote. Quote pricing valid
               for 60 days. Terms: Net 30 (Subject to Credit Approval). All orders subject to acceptance by           Visa, Mastercard, American Express,
               Capsa Solutions. All return items subject to 25% restocking fee, and only coordinated with             Diners Club, Discover, and ACH accepted
               approval from Capsa Solutions. Cancellation of orders in production subject to a cancellation
               fee to be determined based upon progress at time of cancellation


Questions: Contact Heidi Scarberry; Customer Service Representative
               Phone: 800-437-6633
               Fax:    888-490-4164
 Quote                                                                                                                  P.O.
 Acceptance                                                                                                             Number

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Mds cart slmc e000000142[1]

  • 1. Capsa Solutions LLC Created by Heidi Scarberry 4800 Hilton Corporate Dr Customer # C003307 Columbus OH 43232 Salesperson Expiration Date 8/12/2011 Sold To: ASIAN MEDICAL DISTRIBUTORS Ship To: ASIAN MEDICAL DISTRIBUTORS Quote Rev 0 INC INC 1589 MAYHALIGUE ST. 1589 MAYHALIGUE ST. SANTA CRUZ SANTA CRUZ MANILA 1003 MANILA 1003 PHILIPPINES PHILIPPINES Quote Number Quote Date Requested By Email Address Phone Number Fax E000000142 7/13/2011 Line Item Number / Description UM Quantity Unit Price Discount % Extended Price 1 19203 EA 1.000 1,771.35 40.00 1,062.81 MDSE DELUXE CART (NC) 2 19004 EA 2.000 80.01 40.00 96.01 MDS 3" DELUXE DWR. W/DIV. WALLS 3 8200 EA 6.000 100.07 40.00 360.25 TTC CASSETTE W/4.5" BINS 4 8211 EA 6.000 0.00 0.00 TTC LOCK SYSTEM 5 8184-GT EA 36.000 0.42 40.00 9.07 TTC BIN DIVIDER 4.5"-GT 6 19091 EA 2.000 92.03 40.00 110.44 MDS 6" DELUXE DWR. W/DIV. WALLS 7 10386B EA 1.000 74.29 40.00 44.57 WASTE STORAGE CONTAINER-COMPLETE 8 10392E EA 1.000 90.67 40.00 54.40 WRITING SURFACE EXT.-GRAY TAUPE 9 P7048-1 EA 1.000 65.36 40.00 39.22 KENDALL SHARPS CASE W/SAMPLE, NO LADDER 10 P7049B EA 1.000 41.11 40.00 24.67 KENDALL GLOVE BX AND MNT, NO LADDER 11 BRAKE EA 1.000 11.76 40.00 7.06 ADDITIONAL BRAKING CASTER UPCHARGE 12 9564B EA 1.000 85.94 40.00 51.56 I.V. POLE-COMPLETE FOR X-90 13 10219 ST 4.000 20.74 40.00 49.78 MDS DRAWER DIV. SET-GRAY TAUPE 14 8078 EA 36.000 0.95 40.00 20.52 HOSPITAL BIN NAME TAG HLDR-4.5 Page 1 of 2
  • 2. Line Item Number / Description UM Quantity Unit Price Discount % Extended Price 15 10180-SD-C EA 1.000 0.00 0.00 TOP CAP, SMALL-SAND-COMPLETE 16 10434 EA 2.000 0.00 0.00 TOP CAP CORNER BUMPER 17 9420 EA CORE, REMOVABLE 2.000 34.28 68.56 Terms: By signing Quote Acceptance, the customer agrees to the price and accuracy of the quote, and Sales Total 1,998.92 accepts all terms and conditions as outlined within the attached terms document. Domestic Misc Charges 0.00 shipments: FOB Factory; International shipments: EX-Works Factory, freight quote subject to Sales Tax 0.00 change based on destination, fuel surcharges, force majeure or guaranteed delivery window of Invoice Total 1,998.92 expedited route. Special Delivery needed must be noted at time of quote. Quote pricing valid for 60 days. Terms: Net 30 (Subject to Credit Approval). All orders subject to acceptance by Visa, Mastercard, American Express, Capsa Solutions. All return items subject to 25% restocking fee, and only coordinated with Diners Club, Discover, and ACH accepted approval from Capsa Solutions. Cancellation of orders in production subject to a cancellation fee to be determined based upon progress at time of cancellation Questions: Contact Heidi Scarberry; Customer Service Representative Phone: 800-437-6633 Fax: 888-490-4164 Quote P.O. Acceptance Number Page 2 of 2