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	Peg Perego - Siesta High Chair Ice SKU: SIESTAICE Out of Stock		$329.99	$329.99

1	Rice Lake 550-10-1BLE Digital Physician Chair Scale with BlueTooth - 660 x 0.2 lb SKU: 194740 In Stock - Ships within 24 hours		$1,357.00	$1,357.00

1	Diaper Dude 104G FAUX SUEDE W/ GUITAR STAMP SKU: 104G In Stock - Ships within 24 hours		$120.00	$120.00

		Truck Shipping	$240.00	$240.00


			Total	$2,046.99