On-Line Ordering Form

Request prices here† (Please provide us with your name, organization and the country of the billing and shipping addresses so that we can provide you with the appropriate information.) †prices are not available on-line.

If ordering from outside of the US or Canada, please refer to our international ordering instructions (download here), or contact customer service for further information:

1-408-253-8574 or e-mail at alzetcs@durect.com

Use this form to place an on-line order for ALZET pumps using purchase orders (PO). If you are placing an order using a credit card (US and Canada only), please call ALZET Customer service at 877-922-5938, or download and fill out the ALZET fax order form.

DURECT accepts the following credit cards:

ALZET Customer Service will contact you by the next business day to confirm your order and pricing information. Required fields are marked in red.

Name:
Organization:
Department:
Purchase Order*:
Email:
Address:
City:
State:
Zip:
Country:
Phone: (e.g., 4082538574)
Fax:
Customer Account Number:
*Purchase Orders (POs) should be made out to DURECT Corporation
Order placed by :
Contact phone :

Complete if order ships to another address
Name:
Organization:
Department:
Address:
Address:
City:
State:
Zip:
Country:
Phone: (e.g., 4082538574)

Shipping Options:

For orders over 200 pumps, please call for shipping cost.

Item	Order #	QTY
ALZET pump model 1003D	0000289
ALZET pump model 1007D	0000290
ALZET pump model 1002	0004317
ALZET pump model 1004	0009922
ALZET pump model 2001	0000292
ALZET pump model 2001D	0000294
ALZET pump model 2002	0000296
ALZET pump model 2004	0000298
ALZET pump model 2006	0007223
ALZET pump model 2ML1	0000323
ALZET pump model 2ML2	0000325
ALZET pump model 2ML4	0000327

Pumps ordered in multiples of 10

Brain Infusion Kits contain materials for 10 infusions

ALZAID Kits contain materials for 4 tests

Filling tubes ordered in multiples of 10

Item	Order #	QTY
ALZAID Chemical Compatibility Test Kit	0004750
ALZET Brain Infusion Kit 1	0004760
ALZET Brain Infusion Kit 2	0008663
ALZET Brain Infusion Kit 3	0008851
Polyethylene Catheter Tubing (10 per bag)	0007750
Vinyl Catheter Tubing (10 per bag)	0007760
Mouse Jugular Catheter (each)	0007700
Mouse Jugular Catheter Adjustable Length (each)	0007701
Mouse Jugular Catheter Adjustable Length-Large Tip (each)	0007702
Rat Jugular Catheter (each)	0007710
Rat Femoral Catheter (each)	0007720
Rat Femoral Tapered Catheter (each)	0007730
Rat Intrathecal Catheter (each)	0007740
Rat Intrathecal Catheter-Short (each)	0007741
Loctite Adhesive, 3 gram tube	0008670
Filling Tubes (100 μl pumps)	0007988
Filling Tubes (200 μl pumps)	0007987
Filling Tubes (2ml pumps)	0007986

Special Instructions / Other Products / Message to Customer Service:

Pricing

ALZET Customer Service will contact you by the next business day to confirm your order and to supply pricing information. You may wish to print this form before submitting your order so you have a copy for your records.

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