Achat Jeu Roulette Casino Machine A Sous Jouer Gratuite Kitty

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Achat Jeu Roulette Casino Machine A Sous Jouer Gratuite Kitty
ORDER FORM
®
BILL TO
SHIP TO
(Please Print)
Name
Name
Company
Company
Street
Street
City
City
State
Zip
(If Different)
State
Zip
Phone
Please fax or mail this form to take advantage of these Promotional Rates
Complimentary of:
Fax
Athletic Rehab Institute - Terry Trundle ATC, LAT, PTA
E-mail
BEST CLINICAL VALUE
Product Description
Unit Price
Clinic Movement Health System
(Includes the UE Ranger, Wall Mount and Clinical Applications Manual)
$246.50
$273.50
UE Ranger
(Includes Clinical Applications Manual)
$139.95
$154.95
Home Movement Health System
(Includes the UE Ranger, Door Mount and Clinical Applications Manual)
$161.50
$178.50
Wall Mount
(Clinic Applications)
$134.95
$148.95
Door Mount
(Home Applications)
$43.95
$47.95
Additional Clinical Applications Manual
(Shipping Included for this item)
$17.95
Shipping & Handling
Via United Parcel Service (UPS)
Quantity
Total Price
Subtotal
NE Residents Add
7% Sales Tax
Each
UE Ranger
$16.95
Wall Mount
$24.80
Door Mount
$15.25
Clinic Movement Health System
$41.75
Home Movement Health System
$21.95
Shipping & Handling
TOTAL
METHOD
OFOF
PAYMENT
METHOD
PAYMENT
Check Enclosed
Charge to:
Rehab Innovations, Inc.
8727 Ames Ave.
Omaha, NE 68134
Phone (402) 210-8406
Fax
(402) 614-5283
[email protected]
www.ueranger.com
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Card #
Expiration Date
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3 Digit Code
Card Holder’s Name
Signature
Purchase Order Number
Invoice Payment Option (Terms net 30 days - signature required)
Signature