NeoNatalie Purchase Order

To order NeoNatalie products, please fill in this form and email it .

For more information about the NeoNatalie products, see

Please direct any questions relating to this form or the NeoNatalie products in general to .

  1. Contact details
  2. Name of institution submitting order:
  3. Contact person:
  4. Email address of contact person:
  5. Date of order submission:
  1. Project information

In support of the UN Millennium Development Goal 4 Laerdal has committed to providing the NeoNatalie Newborn Simulator and the NeoNatalie resuscitation devices to developing countries on a not-for-profit basis through 2015. See for the list of 68 countries that qualify for not-for-profit prices.

  1. Please state in which country the NeoNatalie products will be used:
  2. Please provide a short description of the project:
  1. Order specification

Please state order quantity of the relevant products in the table below:

Cat. No / Product description / Not-for-profit price
(excl. freight, customs, etc.) / Quantity
104-10001 / NeoNatalie Basic (dark) / USD 50
104-10002 / NeoNatalie Basic (light) / USD 50
104-10003 / NeoNatalie Complete (dark) / USD 70
104-10004 / NeoNatalie Complete (light) / USD 70
846030 / NeoNatalie Resuscitator / USD 15
986000 / NeoNatalie Suction / USD 3
  1. Shipping information

a. Date materials are needed at end destination[1]:

b.Shipping address:

Name of consignee:

Street:

Post code:

City:

Country:

c.Contact person for the shipment:

Name:

Phone:

Email:

d.Freight forwarder:

Delivery terms are FCA (Incoterms 2000), Laerdal Warehouse Suzhou, China. This means we would like you to provide contact details to your freight forwarder, and we will coordinate shipments with them. If you do not have a freight forwarder, shipment can be arranged through Laerdal’s freight forwarder.

Name of your freight forwarder:

Contact information: Email:

Telephone:

Wedo not have a freight forwarder. Please arrange shipping through Laerdal’s

freight forwarder. The following shipping method is preferred:

Air express (door-to-door)

Air regular (door-to-airport)

Sea (door-to-seaport)

  1. Import documents:

Depending on shipping destination, there may be requirements to import licence, country of origin certificate, etc. that needs to be considered and planned before shipment of the order. Please investigate the requirements that apply in the relevant country and provide the following information:

  1. Import licence

We hold an import licence

We will obtain an import licence before shipment arrives

Import licence is not required

We will investigate whether this is required

  1. Country of origin certificate

This is needed in order to import the order to the relevant country

Country of origin certificate is not required

We will investigate whether this is required

  1. Other documents

If other documents are required, please specify:

  1. Invoice details

Please provide the following information:

Name:

Street:

Post code:

City:

Country:

  1. Other comments

Please provide any other comments here:

For internal use:

Received:

Accepted:

PO#:

1

[1] The total lead time from placement of order until the order is delivered at the end destination is the sum of:

a)Lead time for delivery of order from Laerdal’s plant in Suzhou, China.

The lead time is up to4 weeks. Small orders may have shorter lead time.

b)Transit time for the shipment from Laerdal’s plant to end destination.

This depends on choice of shipping method (see section 4d), time needed for customs clearance, etc.

Please contact us at if you have any questions about the lead time and/or estimated transit time for the shipment.