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 *(05) Year*(2024)

Visa MasterCard Amex Discover

Quantity	Name		Price EA	Total

1	LifeSource UM-211-ST Rolling Stand with Basket (15 in Dia. base) For UM-211 SKU: UM-211-ST In Stock - Ships within 24 hours		$279.00	$279.00

1	LifeSource CUF-KS-LL Small Cuff 16 - 19.7 inch (40.64 - 50 cm) For UM211 SKU: CUF-KS-LL In Stock - Ships within 24 hours		$64.99	$64.99

1	LifeSource TB-268 AC Adapter For UM-211 SKU: TB-268 In Stock - Ships within 24 hours		$139.99	$139.99

		Ground, UPS	$54.50	$54.50


			Total	$538.48