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ORDER FORM
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BILL TO
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Name
Company
Company
Street
Street
City
City
State
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(If Different)
State
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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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