Hand Sanitizer, Wipes, Dispensers and Stands Contract

State Use Program

(505ENT-U22-SANITIZER-01)

Supplier Name
Opportunities, Incorporated
Training & Fulfillment Center

Address
100 E. Blackhawk Drive
Fort Atkinson, WI 53538

Supplier Terms & Conditions

Contract Specification And Pricing List Is Located On VendorNet.

Product Description Catalog #: Package: Unit Price:
Sanitizer – 16oz Bottle Sanitizer16oz 2/pack $19.30
Sanitizer – 1 Gallon SanitizerGal 1/pack $40.18
Sanitizing Wipes – 75ct Canister Wipes75ct 3cans/pack $39.29
Touchless Electronic Dispenser Dispenser 1 each $49.30
Universal Floor Stand Kit Floorstand 1 each $119.02
Sanitizer Order Form

Buyer Information:

Name:
Name:
First
Last

Shipping Information:

Shipping Address: *
Shipping Address:
Address Line 1
Address Line 2
City
State
Zip Code

Order Information:

Select Items Needed
Hand Sanitizer Bottles (#F008029-F)
Hand Sanitizer 1 Gallon (#R001955)
Sanitizer Wipes (#F007769-F)
Hand Sanitizer Dispenser (#R001959)
Dispenser Floor Stand (#R001960)

Charge P-Card:

Name on P-Card:
Name on P-Card:
First
Last

Charge Card on File:

Cardholder Name:
Cardholder Name:
First
Last
I hereby authorize Opportunities, Inc. to charge my card on file that include the last 4 digits above for the total balance listed below.

Call For Payment:

Name of Contact For Payment:
Name of Contact For Payment:
First
Last
Preferred Time For Call:
Total