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	HealthOMeter 400KL Balance Beam Scale 390 x 1/4 lb SKU: 400KL In Stock - Ships within 24 hours		$222.00	$222.00

1	Convaid CX12 902845-903854 Cruiser Cordura 30 Degree Fixed Tilt Wheelchair - Panther Black SKU: 902845-903854 Out of Stock		$1,876.00	$1,876.00

1	Convaid CX18 902594-903856 Cruiser Cordura 30 Degree Fixed Tilt Wheelchair Stroller - Nile Green SKU: 902594-903856 Out of Stock		$2,036.00	$2,036.00

1	Diaper Dude 1101 BLACK MS W/FLAP SKU: 1101 In Stock - Ships within 24 hours		$98.00	$98.00

		Ground, UPS	$0.00	$0.00


			Total	$4,232.00