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Name: |
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Address: |
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City, State, Zip |
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Phone: |
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E-Mail: |
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| Item Description: |
Each: |
Quantity: |
Total: |
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EKG Study Guide - Print Edition: |
$24.95 |
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EKG Study Guide - Electronic Edition: |
$14.95 |
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12-Lead EKG Overlay - for PhysioControl: |
$19.95 |
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12-Lead EKG Overlay - for Phillips: |
$19.95 |
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12-Lead EKG Overlay - for Zoll: |
$19.95 |
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Subtotal: |
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*Sales Tax:
(6.75%) |
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Shipping:
(free shipping when purchasing electronic edition alone, and on
domestic orders over $100 |
$7.00 |
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Total: |
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| Shipping Information: |
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Ship to same as above? |
Yes -
| No -
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Name: |
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Address: |
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City, State, Zip |
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Phone: |
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E-Mail: |
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| Comments / Delivery Instructions / Etc... |
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Payment Information - Visa & MasterCard Accepted!
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Cardholder's Name (as it appears on the card): |
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Card Number (no dashes, please): |
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Expiration Date (mm/yy format): |
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CSC Code: (what is a CSC code?) |
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ELECTRONIC SIGNATURE - By checking the box to the right, you confirm that you are an authorized card holder, agree
to the terms of your credit card company, and hereby authorize Central Ohio Emergency Medical Associates (COEMA), LLC to
complete your purchase as described above... |
I agree - |
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FOR YOUR INFORMATION - Your credit
card information will not be processed for authorization until your products are ready to ship from our office. If you have any
questions, or would like to arrange for an alternative method of payment, please contact us directly at
740-272-1463. |
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