<%@LANGUAGE="VBSCRIPT" CODEPAGE="1252"%> <% ' if form is submitted, build message and e-mail results using the script included above if (request.form("submitted")) then message = buildMessage () mailForm (message) end if %> UltraScope Stethoscopes
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UltraScope Order Form
MAXIScope Order Form
Model: 
Head & Tubing Color: 
Engraving: 

 
Top Line: 
Bottom Line: 


Engraving Comments:
Total
MAXIScope: $   
Engraving: $   
Shipping/Handling
Charges
BC  AB 
SK  MN  ON  PQ  MT  NWT  

Shipping $   


Subtotal $   
Tax @ 6% $   
Grand Total: $   

  
Personal Information
 

Name (First & Last)

Phone (include area code)

Address

 

 

 

 

City

Prov.

Postal Code

Email Address

 

 

 

 

 

 

 

Credit Card Type - Visa/Mastercard
(Sorry, we do not accept C.O.D. orders.)

Credit Card Number

Card Expiry Date:

 

Name as it Appears on Card

 

 

Shipping and Handling Policy

  • All items are shipped via Purolator courier service unless otherwise specified.
  • Registered Express Post option is available for signed delivery service only.
  • Delivery times may vary. Please allow up to 6 weeks for delivery of your order. We can not guarantee delivery times.
  • If the product ordered is unavailable or a delay is expected you will be notified by phone or email with in 1 week of receipt of your order.

Customer Service Policy

  • 100% satisfaction guaranteed.
  • All products are returnable for a full refund of the product cost only if manufacturer defect.*
  • *Specially engraved items returnable only if manufacturer defect or damage present.

By Submitting this form, you verify the following:

  • You have carefully checked your order before submitting. If you have any questions, contact Associated Health Systems.
  • You are of lawful age to make this transaction.
  • You have read, understand, and agree to all of the conditions which lie here-in.
  • You authorize Associated Health Systems to charge the above listed credit card for all fees incidental to this order.

Scope Designs
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