ORDER FORM
MAILING INFORMATION NAME:____________________________________ ADDRESS:_________________________________ __________________________________________ _____________________PC/ZIP:_______________ PHONE: (____)______-___________ FAX: (____)______-_____________ OTHER INFO:_______________________________ __________________________________________ __________________________________________ |
METHOD OF PAYMENT Please check one of the following. MASTER CARD___ VISA___ CARD NO._________________________________ EXPIRATION DATE____/____/____ SIGNATURE________________________________ Price per unit in US dollars. |
ITEM | QUANTITY | PRICE PER UNIT | TOTAL |
EXERLOPERS | ________ | 199 | $______.___ |
INSTA-PULSE 105 | ________ | 159 | $______.___ |
INSTA-PULSE 107 | ________ | 149 | $______.___ |
INSTA-PULSE WALL | ________ | 349 | $______.___ |
INSTA-PULSE FLOOR | ________ | 399 | $______.___ |
ANTENSE | ________ | 169 | $______.___ |
INSTA-RUNNER | ________ | 399 | $______.___ |
BODY-TRIM | ________ | 49 | $______.___ |
For more information please contact Biosig Instruments
toll free at
1-800-463-5470 or Fax (514) 637-1353
Email: biosig@biosig.net
Mailing Address: PO Box 860, Champlain NY 12919
(Please inquire or send an order by email or fax)
Home | Insta-Pulse Heart Rate Monitors | Antense | Exerlopers | Insta-Runner | Body Trim | Awards & Medals | Price List |Biosig in Press