Order Now and Save! Print this ORDER FORM. Fax (1-781-235-3252) or Mail Order if you do not want to order on-line. Your choice: Order ON-LINE: (via our secure link) by clicking 'ORDER This ITEM' next to the item you want to purchase (do not forget to check-out) or PRINT and use this ORDER FORM. Call (800) 549-0095 for questions. Name.....:________________________________________________ Address..:________________________________________________ City.....:_____________________________ Phone: ______________ Zip......:__________________State or Country:______________________ Payment by: ___ Check/Money Order enclosed ___ Charge my credit card ___MasterCard ___VISA ___AMEX ___Discover ___Diner's Club |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__| Exp. Date: _________ Signature: _____________________________ Please send me: (We can ship to a different address - please indicate) _____ e-pill 7-Day Organizer & Reminder WORLD's BEST! ($59.95 canvas case, 7 high capacity organizers, electronic reminder _____ e-pill Multi-Alarm Easy-to-Program Pocket Medication Reminder ($39.95 complete w/ soft case & batteries) _____ e-pill Multi-Alarm Pill Box EZ Program Medication Reminder ($49.95 complete w/ batteries) _____ e-pill MEDGlider Organizer & 4 Alarm Reminder complete ($45.95 Reminder w/batteries, 1 organizer and Tray) _____ e-pill MeDose Vibrating 6 Alarm Watch with Leather band ($99.95 Color: __ Black & Silver / black band) _____ e-pill Almeda 6 Alarm Analog (with Face and Hands) Vibrating 6 Alarm Watch with Leather band ($195.00 Color: __ Stainless Steel) _____ e-pill Med-Time Reminder & Automatic Dispenser complete ($289.95 w/batteries, 2 medication trays lock w/ key (2), prescription card, manual) _____ e-pill Parkinson's Sipping Bottle. Easy to Hold Sipping bottle for better fluid intake ($4.95 / Green) _____ e-pill Pager Vibrating Multi-Alarm Reminder (12 Alarms). Carry it in your pocket, purse or on your belt. ($75.95 w/batteries and Belt Clip) _____ e-pill CADEX Text 12 Alarm Reminder & Medication ID Watch ($79.95 /rubber strap. Color: __ Silver __ Black) _____ Watch Accessory ($9.95): __ Pendant kit __ Blue strap __ Red strap __ Diabetes __ Medical Condition __ Brown strap _____ e-pill Once-A-Day Medication Reminder ($5.95 2 per pack) _____ e-pill PERS Help-At-Hand Model 911 (No Monthly Fees) PERS system (Special $199.00 complete w cord, AC adapter, manual, main unit, 2 pendants w/ batteries) _____ e-pill Cube Pillbox Timer up to 24 daily alarms ($24.95 complete w/ batteries) _____ Mass residents please add 5% sales tax. _____ Shipping and Handling (FREE Standard Shipping, Outside US $15.00/order) _____ ORDER TOTAL .... My Time-Zone: ______ (for FREE set-up) MAIL ORDERS: 49 Walnut Street, Bldg. 4 Wellesley, MA 02481, USA http://www.epill.com Shipping & Handling: $5.95 per order (Outside US $15.00/order) |
