Rx DESTROYER™ offers hospitals, clinics, and surgery centers an environmentally safe means of disposing of unused or expired drugs that conforms to the DEA’s latest standards of drug disposal and destruction. Because Rx DESTROYER™ is completely portable it can be easily stored in close proximity to the drugs themselves, making it the perfect tool to mitigate drug diversion.

Rx DESTROYER™ Order Form

Name of the person placing order *

Email Address *

Contact Phone Number *

Purchase Order Number

If applicable

GPO Membership

If applicable

Tax Status *

If you are Tax Exempt, please email a copy of your exempt certificate to customerservice@gfmd.com.

Taxable

Tax Exempt

Shipping Method *

Carrier Account #

If applicable

Carrier Name & Account # *

Shipping Address

Healthcare Institution / Company *

Attention

Address *

City *

State *

Zipcode *

Billing Address

Same as Shipping Address

Healthcare Institution / Company

Attention Copy

Address *

City *

State *

Zipcode *

Please enter the quantity for each item that you wish to order.

ALL PURPOSE PRODUCTS

RX30

Rx Destroyer™ 30 gallon – 1 each

RX5.0

Rx Destroyer™ 5.0 gallon – 1 each

RX2.5

Rx Destroyer™ 2.5 gallon – 2 each / case

RX1.0PRO

Rx Destroyer™ 1.0 Pro gallon – 4 each / case

RX64

Rx Destroyer™ ½ gallon – 4 each / case

RX64PRO

Rx Destroyer™ ½ gallon Pro Series – 4 each / case

RX16

Rx Destroyer™ 16 ounce – 12 each / case

RX4

Rx Destroyer™ 4 ounce – 24 each / case

FOR LIQUIDS PRODUCTS

RX5.0LIQ

Rx Destroyer™ 5.0 gallon w/hardener – 1 each

RX2.5LIQ

Rx Destroyer™ 2.5 gallon w/hardener – 2 each / case

RX1.0PROLIQ

Rx Destroyer™ 1.0 Pro gallon w/hardener – 4 each / case

RX64LIQ

Rx Destroyer™ ½ gallon w/hardener – 4 each / case

RX64PROLIQ

Rx Destroyer™ ½ gallon Pro Series w/hardener – 4 each/case

ACCESSORIES

Hardener Packets

RX64HARD

Hardener Packets – 4/pkg

RX1.0HARD

Hardener Packets – 8/pkg

RX2.5HARD

Hardener Packets – 10/pkg

RX5.0HARD

Hardener Packets – 10/pkg

Funnels

RXFUN

Universal Funnel – 1 each

RXFUN32

32 OZ. Deluxe Transparent Funnel W/Lid – 1 each

Wallmount 2.5 gallon

RX2.5W/SEC

Wallmount 2.5 gallon w/secure – 1 each

RX2.5W/SECL

Wallmount 2.5 gallon w/secure & lock – 1 each

Wallmount 1 gallon

RX1.0W/SEC

Wallmount 1 gallon w/secure – 1 each

RX1.0W/SECL

Wallmount 1 gallon w/secure & lock – 1 each

Wallmount 64 Oz

RX64W/SEC

Wallmount 64 oz w/secure – 1 each

RX64W/SECL

Wallmount 64 oz w/secure & lock – 1 each

RX64PROW/SEC

Wallmount 64 oz Pro Series w/secure – 1 each

RX64PROW/SECL

Wallmount 64 oz Pro Series w/secure & lock – 1 each

Wallmount 16 Oz

RX16WALL

Wallmount 16 oz – 1 each

Other

RXCAB

Rx Destroyer™ Security Cable (cable only) – 1 each

RX1.0LCKBX

Rx Destroyer™ LockBox 1 gallon – 1 each

RX64LCKBX

Rx Destroyer™ LockBox 64oz – 1 each

RX64PROLCKBX

Rx Destroyer™ LockBox 64 oz Pro Series -1 each

RXCAPS

Rx Destroyer™ Vented Caps (fits 16oz, 64oz, & 1.0 gallon bottles) – 12 each / case

RX2.5CAPS

Rx Destroyer™ 2.5 Gallon Bottle Vented Caps – 6 each / case

Tap A Drop 0.5 fl oz

400-PR – 12 each / case

RXDOLLY

Rx Destroyer™ Dolly for the 5 gallon container – 1 each

(800) 405-3600

Monday – Friday

(800) 405-3600

Order Form

Rx DESTROYER™ Order Form

Shipping Address

Billing Address

Please enter the quantity for each item that you wish to order.

ALL PURPOSE PRODUCTS

FOR LIQUIDS PRODUCTS

ACCESSORIES

Hardener Packets

Funnels

Wallmount 2.5 gallon

Wallmount 1 gallon

Wallmount 64 Oz

Wallmount 16 Oz

Other

Navigation

Billing, Accounts
Payable and Ordering

Sales, Product and Technical Support

(800) 405-3600

Monday – Friday

(800) 405-3600

Rx DESTROYER™ Order Form

Shipping Address

Billing Address

Please enter the quantity for each item that you wish to order.

ALL PURPOSE PRODUCTS

FOR LIQUIDS PRODUCTS

ACCESSORIES

Hardener Packets

Funnels

Wallmount 2.5 gallon

Wallmount 1 gallon

Wallmount 64 Oz

Wallmount 16 Oz

Other

Navigation

Billing, Accounts Payable and Ordering

Sales, Product and Technical Support

Billing, Accounts
Payable and Ordering