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 A683210270009 AC Adapter for Seca 777 787 797 SKU: A683210270009 In Stock - Ships within 24 hours		$59.00	$59.00

1	Convaid CX16 900145-903852 Cruiser Cordura 30 Degree Fixed Tilt Wheelchair - Deep Burgundy SKU: 900145-903852 Out of Stock		$2,036.00	$2,036.00

1	Adaptive Star APW-1800 Postioning Wedges Set SKU: APW-1800 In Stock - Ships within 24 hours		$235.99	$235.99

1	Detecto 6400-C-AC Portable Wheelchair Scale 32 in x 36 in with BT / WiFi and AC Adapter - 1000 lb x 0.2 lb SKU: 6400-C-AC In Stock - Ships within 24 hours		$2,637.30	$2,637.30

1	UPPAbaby 0080R, Cabana Car Seat Shade Denny (Red) - Open Box SKU: 0080R-Open Open Box In Stock - Ships within 24 hours		$24.99	$24.99

1	Child's Round Table w/shelf & Two chairs 524E - Espresso SKU: 524E In Stock - Ships within 24 hours		$220.00	$220.00

1	Convaid EZ16 900996-903464 EZ Rider 10 Degree Fixed Tilt Special Needs Stroller - Navy Blue SKU: 900996-903464 Out of Stock		$1,535.40	$1,535.40

		Truck Shipping	$372.40	$372.40


			Total	$7,121.08