Acute Electrode

Bill To: (Please provide the billing address)

Deliver To: (Please provide the shipping address)

Shipping and Handling

1—5 boxes $85.00

6—10 boxes $105.00

11—20 boxes $120.00

Credit Card

Purchase Order

Note: - Please fax a copy of the Purchase Order to
+972 (0) 4 6574075 Or 877-471-2055

Detailed explanation of the choices