HealthCheckSystems

Billing Address
(As shown on your credit card statement.)
First name * Last name * Company Name Address * Address2 City State\Province: * Zip/Postal Code * Country * Day Phone * Cell Phone Fax Email *
Shipping Address
First name * Last name * Company Name Address * Address2 City * State\Province * Zip/Postal Code * Country * Day Phone * Cell Phone Fax
Payment Info
Name on card * Credit Card number * CVV *

Month *(12) Year*(2025)

Visa MasterCard Amex Discover

Quantity	Name		Price EA	Total

1	Convaid EZ18 900351-903464 EZ Rider 10 Degree Fixed Tilt Special Needs Stroller - Navy Blue SKU: 900351-903464 Out of Stock		$1,535.40	$1,535.40

1	Rice Lake RL-350-6-BT Portable Bariatric Wheelchair Scale Two Ramps with Bluetooth 1000 x 0.2 lb SKU: 168358 In Stock - Ships within 24 hours		$1,600.00	$1,600.00

1	Convaid CX18 902594-903467 Cruiser Textilene 30 Degree Fixed Tilt Wheelchair Stroller - Raspberry SKU: 902594-903467 Out of Stock		$2,036.00	$2,036.00

1	Detecto P-150 Mobile Tape Printer With Serial Interface SKU: P-150 In Stock - Ships within 24 hours		$998.44	$998.44

		Truck Shipping	$241.30	$241.30


			Total	$6,411.14