CardioCare Stethoscope Store Printable / Faxable Order Form

AMT Stethoscopes logo

Use this printable blank order form if you can't get the shopping cart system to work, or if you prefer to fill it out by hand. Use your browser to print this page, then fill in the blanks and send with your check or money order, or your credit card billing information.

Credit card orders can be faxed to: (216) 991-8806 and will normally be shipped within two business days. Mail orders with personal checks will be held for up to 10 days for the check to clear.

Mail to:

ADVANCED MEDICAL TECHNOLOGIES, INC.
P.O. Box 22558
Cleveland, OH  44122

Phone: (216) 283-1010

Or fax to: (216) 991-8806

                  
Part Number Item Description Price, each Quantity Total
         
         
         
         
         
         
         
         
         
      Subtotal:  

Ohio Residents, please add 7.5% sales tax:

 

($6.95 shipping & handling applies to EACH stethoscope. $5.95 shipping & handling applies to EACH accessory piece or replacement part piece. For Next Day Delivery $25.50 shipping & handling applies.) For International Shipments please contact us for shipping charges.

Shipping:

 

Total  

Please fill out the following information.  Be sure to include your email address in case we have a question about your order!  Please note: If this is a gift being sent to an address other than your own, you must also include your own name and the credit card billing address below to make sure your credit card can be approved! Just leave the credit card spaces blank if you are paying by check or money order.

Credit card type:

  □ VISA     □ MASTERCARD       □ DISCOVER      □ AMEX

Credit card number:

  __ __ __ __ - __ __ __ __ - __ __ __ __ - __ __ __ __

Expiration date:

   ___ ___ / ___ ___
Card Verification Number __________ (The last 3 digits on the signature panel on the back of the card.)

YOUR
SIGNATURE:

Purchaser's information:

NAME:

ADDRESS:

CITY:

STATE, ZIP:

PURCHASER'S E-MAIL:

PURCHASER'S PHONE:

Please fill out shipping information below, if different from purchaser's information above.

SHIP-TO: NAME

 

ADDRESS

 

CITY

 

STATE and ZIP

 

  Check here if this is a gift. We will send the receipt to you at "Purchaser's address" instead of putting it in the box!   Message for gift tag:  __________________________________________________________

Thank you for your order!              Questions?   Email Us                                                      [[ RETURN HOME]]