Capital Purchase Program Bundle Options

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Date of Rezum Trial*

Date of Next Procedure*

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Type of Package*

Bundles*

Bundle Option A

Please allow a minimum of two weeks for products to ship.

Olympus	Model:	Price:
Monitor	21" Medical Grade Monitor	$1,500.00
Processor	Olympus Processor	$4,500.00
Camera	OTV S7 PROH-HD-L08E	$7,500.00
Scope	IEC 30-0515-00	$1,995.00
Total		$15,495.00

Storz	Model:	Price:
Monitor	21" Medical Grade Monitor	$1,500.00
Processor	222201011U	$12,800.00
Light Source	LED Portable Battery Operated Light	$275.00
Camera	22220055	$3,995.00
Scope	IEC 30-0515-00	$1,995.00
Total		$20,565.00

Stryker	Model:	Price:
Monitor	21" Medical Grade Monitor	$1,500.00
Processor	1288-010-000	$4,995.00
Light Source	LED Portable Battery Operated Light	$275.00
Camera/Coupler	1288	$1,500.00
Scope	IEC 30-0515-00	$1,995.00
Total		$10,265.00

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Bundle Option B

Please allow a minimum of two weeks for products to ship.

Olympus:	Model:	Price:
Camera	OTV S7 PROH-HD-L08E	$7,500.00
Light Source	LED Portable Battery Operated Light	$275.00
Scope	IEC 30-0515-00	$1,995.00
Total		$9,770.00

Storz	Model:	Price:
Camera	22220055	$3,995.00
Light Source	LED Portable Battery Operated Light	$275.00
Scope	IEC 30-0515-00	$1,995.00
Total		$6,265.00

Stryker	Model:	Price:
Camera/Coupler	1288	$1,500.00
Light Source	LED Portable Battery Operated Light	$275.00
Scope	IEC 30-0515-00	$1,995.00
Total		$3,770.00

Choose Package*

Quantity*

Thank you for choosing Total Scope, Inc. for your Rezum Capital Evaluation. As per your request the trial products you have requested will be provided to you for use while trialing the Rezum product.

To the extent that the Evaluation Period lasts longer than 90 days, Total Scope is required to disclose the value of the Evaluation Equipment under the U.S. Physician Payment Sunshine Act. Or in the event that Customer has not purchased and is still in possession of the Equipment after ninety (90) days, the Customer will be charged and invoiced, and shall pay, a Two Hundred Fifty ($250) monthly rental fee for the period following the ninety (90) days and continuing until such time as the Equipment is purchased by the Customer or returned to Total Scope.

Customer will be responsible for any damage outside of normal wear and tear on all evaluation products while it is in your possession. You will not be responsible for any evaluation products that are damaged upon receipt (please contact us immediately).

Please retain all shipping materials during the trial in the event the product(s) need to be returned.

Thank you for choosing Total Scope, Inc. for your Rezum Program. As per your request the trial products you have requested will be provided to you for use while trialing the Rezum product.

To the extent that the Evaluation Period lasts longer than 30 days, Total Scope is required to disclose the value of the Evaluation Equipment under the U.S. Physician Payment Sunshine Act. Or in the event that Customer has not purchased and is still in possession of the Equipment after thirty (30) days, the Customer will be charged and invoiced, and shall pay, a Two Hundred Fifty ($250) monthly rental fee for the period following the thirty (30) days and continuing until such time as the Equipment is purchased by the Customer or returned to Total Scope.

Please retain all shipping materials during the trial in the event the product(s) need to be returned.

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