Medivac Oxygen Concentrator Purchase Form Purchase Oxygen Concentrator 12 PART I: Client InformationThis field is hidden when viewing the formOrder NumberThis field is hidden when viewing the formDate DD slash MM slash YYYY Client Name(Required)Client NRIC(Required)Client Email(Required) Client Address(Required) Street Name Unit Number Postal Code Oxygen Concentrator Brand(Required) 5 LPM Caire AirSep VisionAire 5 5 LPM Phillips Everflow 10 LPM CAIRE Airsep Intensity All units come with a standard 6-month manufacturing warranty.5 LPM Caire AirSep VisionAire 5 Price: 5 LPM Phillips Everflow Price: 10 LPM CAIRE Airsep Intensity Price: Top Up Oxygen Humidifier Oxygen Mask and/or Tubings Choice number 3 does not have an image Additional 6 months Warranty Choice number 4 does not have an image Delivery [ Next working day ] Oxygen Humidifier Price: Oxygen Mask and/or Tubings Price: Warranty [ 6 months ] Price: Delivery [ Next working day ] Price: This field is hidden when viewing the formTotal Product PriceThis field is hidden when viewing the formTotal Top UpThis field is hidden when viewing the formTotal Price(Required) PART II: Sale of EquipmentBILL OF SALE FOR MEDICAL EQUIPMENTS THIS BILL OF SALE FOR MEDICAL EQUIPMENT (the “Sales Contract”), is made and effective BETWEEN MEDIVAC EMERGENCY AMBULANCE PTE LTD (UEN No. 202320939D) (hereinafter referred to as “Seller”) of the First Part. AND Name ID / Passport Number Address FOR GOOD CONSIDERATION , and in payment of S , the undersigned Seller , hereby sells and transfers to the Buyer the following Medical Equipments in Annex A : ANNEX A # Item Description Quantity Price per unit Amount(S) 1 1 2 Top Up: 1 SELLER WARRANTS THAT : 1. Sale is on a willing buyer willing seller basis ; 2. The medical equipment has been inspected, delivered and accepted by the buyer ; 3. There is no refund or replacement after full payment is made to the seller; 4. Manufacturer Warranty : 6 months from the date mentioned above. 5. This Agreement shall be deemed to be made under and shall be governed by the laws of the Republic of Singapore in all respects, including matters of construction, validity, and performance; 6. In the event of any dispute arising out of the Agreement, all parties shall submit such dispute for resolution pursuant to the exclusive jurisdiction of the Courts of Singapore. EXECUTION PAGE IN WITNESS WHEREOF, the parties has executed this Sales Agreement on this I Agree I Agree Signed and Agreed By :BuyerSignature
