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Print this web page to order - Select Item(s) and Quantity:
Heart
Model - Quantity: _______ @ $299.00 each.
Shipping
and Handling: $14.95 (continental USA)
(Ohio
Sales Tax 6.75%): _______
Total:
_______
Payment - Must Accompany This
Order (Check or Credit Card):
Check made payable to: Helical Heart
Credit Card Company: _________________________________
Credit Card Number: _______________________
Expiration Date: ___________
Shipping Information:
please print
Name: ____________________________________________________________
Title:______________________________________________________________
Company/Institution: _________________________________________________
Address: ___________________________________________________________
City: __________________________________
State: _______ Zip: ___________
Phone: _____________________________
Fax: ___________________________
E- Mail: ____________________________________________________________
Send Order Form and Payment
to:
The Helical Heart Company LLC
3750 Courtright Ct
Columbus, Oh 43227
Questions about your order?
Please call Michelle Evans at (614) 252-6342 ext. 221
Please allow 4 weeks for delivery. |