ORDER FORM

MAILING INFORMATION

NAME:____________________________________

ADDRESS:_________________________________

__________________________________________

_____________________PC/ZIP:_______________

PHONE: (____)______-___________

FAX: (____)______-_____________

OTHER INFO:_______________________________

__________________________________________

__________________________________________

METHOD OF PAYMENT

Please check one of the following.

MONEY ORDER___ CERTIFIED CHEQUE___

MASTER CARD___ VISA___ AMEX___

CARD NO._________________________________

EXPIRATION DATE____/____/____

SIGNATURE________________________________

Price per unit in US dollars.

ITEM QUANTITY PRICE PER UNIT TOTAL
EXERLOPERS ________ 239 $______.___
INSTA-PULSE 105 ________ 159 $______.___
INSTA-PULSE 107 ________ 129 $______.___
INSTA-PULSE WALL ________ 299 $______.___
INSTA-PULSE FLOOR ________ 349 $______.___
ANTENSE ________ 159 $______.___
INSTA-RUNNER ________ 399 $______.___
BODY-TRIM ________ 59 $______.___

Thank you for your order. Have a nice day.

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 PRINT THIS PAGE FOR FAX OR MAIL ORDERS)

Home | Insta-Pulse Heart Rate Monitors | Antense | Exerlopers | Insta-Runner | Body Trim | Awards & Medals | Price List | Order Form | Biosig in Press


We welcome your feedback.
Copyright Exerlopers Fitness Systems