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TENS Pain Control Unit Order Form

 

TENS PAIN CONTROL ORDER FORM

CHECK THE BOX NEXT TO THE PRODUCT NAME AND INPUT THE QUANTITY.

CALL TOLL FREE -- FAX - 24hrs (888) 280-0299 ---- PHONE (888) 293-0728

How to Order Online - Click here for SECURE SHOPPING CART

Product

Description

Price (1)

TENS - transcutaneous electro-nerve stimulator. Dual channel with independent amplitude controls. Pulse rate control, pulse width control, 3 modes: Burst, Modulation, Continuous, timer, battery, case and four electrodes. Comes with a five year warrantee against manufacturers defects. If you ever have a problem simply send it to us for a replacement. You MUST HAVE a doctor's prescription to buy this unit. Please Mail or Fax (619) 296-2242 your doctor's prescription to our office. TENS INFORMATION

$99.00

QTY:

VITAL TENS BASIC UNIT ONLY $59.95

It will be shipped UPS Ground and will be sent within 24 hrs in most cases.

Shipping information:(7.75% Sales Tax in CA only.)

We can only ship to the credit card holder.

Your name:

Email address(For order confirmation):

Company name:

Street address:

City: State: Zip Code:

 Special Instructions:

 Payment Information: (credit card info can be faxed (888) 280-0299 or called (888) 293-0728)

Payment method:

Name on Credit Card:

Credit Card Number: Expiration Date:Format: MMYY

Credit Card Billing Address and Zip:

Daytime telephone number :

   

(We will E-mail you an order confirmation number via e-mail as soon as we process your order.) (If you do not receive an order confirmation number within 24-48 hrs please resubmit your order.) Thank you for your interest in our products.
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