Biomove 3000 Order Form

Amjo Corp - Biomove 3000 Order Form

Please fill in the sections below and fax or mail to: Amjo Corp PO Box 8304 West Chester, OH, 45069 Tel: 513 942 2770 Fax: 513 942 2771
Quantity	Description	** Unit Price	Total
	Biomove 3000 (Includes two sheets of four Biotrode electrodes, patient cable, belt and user manual)	$1395.00
	Sheet of Four Biotrode Electrodes	$30.00
	Sheet of Four Biotrode Electrodes (Five Pack)	$125.00

Sub Total:
[USA Ground S&H=$17.50] Please call for other options > Shipping and Handling:
Grand Total:

Bill To Name:

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Amex □ Visa □ Master Card □ Discover □

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Name:

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Note: A Prescription is Required.
In the USA, this order can only be filled if it is
accompanied by a prescription from a medical doctor.
** Prices are subject to change without notice.