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	Seca 115 Medical PC software for diagnostic assistance - 6 Workstation Licenses SKU: 115306010 In Stock - Ships within 24 hours		$1,728.54	$1,728.54

1	Detecto 6600-C-AC Portable Wheelchair Scale 32 in x 40 in with WiFi / Bluetooth and AC Adapter - 1000 lb x 0.2 lb SKU: 6600-C-AC In Stock - Ships within 24 hours		$3,099.27	$3,099.27

		Truck Shipping	$239.10	$239.10


			Total	$5,066.91