This document is a quote from Capsa Solutions LLC to Asian Medical Distributors for medical equipment and supplies. It lists 17 line items with descriptions, quantities, unit prices, discounts, and extended prices. The total sales amount is $1,998.92. It provides contact information for the sales representative and notes the terms of the quote including payment and cancellation terms.

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
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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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