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 CX10 903314-903850 Cruiser Cordura 30 Degree Fixed Tilt Wheelchair - Mediterranean Blue SKU: 903314-903850 Out of Stock		$1,876.00	$1,876.00

1	DreamBaby F192B 3.5 Inch Extra Tall Gate Extension - Black SKU: F192B Backordered		$16.99	$16.99

1	Detecto IB800-AC Digital In-Bed Scale Adjustable Base with AC Adapter 800 lb x 0.2 lb SKU: IB800-AC In Stock - Ships within 24 hours		$7,389.75	$7,389.75

1	Detecto IB800-C Digital In-Bed Scale Adjustable Base with WiFi / Bluetooth 800 lb x 0.2 lb SKU: IB800-C In Stock - Ships within 24 hours		$7,389.75	$7,389.75

		Truck Shipping	$909.20	$909.20


			Total	$17,581.69