Products

SECQUIRE Order Forms

You can order Secquire Products at the Platelet Gel Network, otherwise

Please fill out order forms and fax your orders to the number provided below:

First Time Orders

First time customers must provide credit card information and credit references in order to establish a purchasing account with PPAI Medical.  Please fill out and fax the credit application and payment agreement prior to ordering. 

Customers Requesting Demos

Please fill out the Demo/Trial form for the Centrifuge Machine and disposable supplies you would like to try.  Provided with a Secquire Centrifuge demo machine are 4 Secquire Kits.  Please email or call us to request  additional items.

Forms (PDF)

• Credit Card Application (first time orders)

• Payment Agreement (first time orders)

• Demo/Trial (free trial form)

• Call for Product Order Form

• Online Orders

For more information please call: