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 903314-903857 Cruiser Cordura 30 Degree Fixed Tilt Wheelchair - Forest Green SKU: 903314-903857 Out of Stock		$1,876.00	$1,876.00

1	Rice Lake 160-10-7 Low-Profile Digital Physician Scale 550 x 0.2 lb SKU: 178518 Available		$520.00	$520.00

1	Convaid CX10 903314-903851 Cruiser Cordura 30 Degree Fixed Tilt Wheelchair - Purple SKU: 903314-903851 Out of Stock		$1,876.00	$1,876.00

1	KidCo S3362 Magnet Starter Set SKU: S3362 Out of Stock		$18.95	$18.95

1	Rice Lake 9V AC Adapter 120V/230V SKU: 133077 In Stock - Ships within 24 hours		$30.00	$30.00

1	Detecto P-24 White Baked Epoxy Steel Step-On Can Waste Receptacle 24 Quart Capacity SKU: P-24 In Stock - Ships within 24 hours		$163.80	$163.80

		Ground, UPS	$73.20	$73.20


			Total	$4,557.95