To order the Intellewave HRV system by fax please
click here and print this form
To order the Intellewave HRV system online please fill out the form below:
First Name:
Last Name:
Company:
Direct Phone:
Cell:
Email:
Your PO#:
Date:
July 24, 2008
Name of distributor:
ITEM NO.
Enter QTY
DESCRIPTION
PRICE
1
Intellewave HRV System
Available upon request
2
Expert Correction Service per
Intellewave Test Unit
$25.00
SHIPPING & HANDLING *
Fedex Ground - FREE
Fedex 2nd Day - $45 per unit
FedEx Overnight - $75 per unit
*Applicable for USA only
Payment By:
Visa
MC
American Express
Discover
Check
Echeck
Wire
To provide us with payment instructions, please leave your contact information (phone number and best time to reach you) or send fax at 732-738-8877 or call us at 732-738-8800.
My Contact Info:
Shipping Address:
First Name:
Last Name:
Company:
Address:
City:
State:
Zip code:
Country:
Direct Phone:
Cell:
Fax:
Email:
Web site:
Billing Address:
Same as shipping address
First Name:
Last Name:
Company:
Address:
City:
State:
Zip code:
Country:
Direct Phone:
Fax:
Notes or Special Instructions:
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