TeleEMG Online Store Fax Order Form
65 Arlington Road
Tel: (617) 840-3253 – Fax:
(781) 937-3081
Print, Fill and FAX to: 781-937-3081
All Prices include Priority USPS Shipping and
Handling. FedEx shipping is extra. Delivery can only be guaranteed when shipping
by FedEx.
Ship
by USPS - Priority Mail (Free)
Ship
by FedEx - US Orders Only (Add $40)
Ship
by FedEx - International Orders Only (Add $100)
Select a product from the list below:
The Nerve Conductions Course:
$462 (Save $88)
The Nerve Conductions Course - Light:
$224
The Needle Examination Course:
$1134.00 (Save $171)
The Needle Examination Course - Light:
$422.00
The Integrated EMG and NCS Course:
Price: $1484.00 (Save $347)
The Integrated EMG and NCS Course - Light:
Price: $642
EMG
Manual: ($24)
EMG Training CD:
($246)
Sensory Conductions & EMG Manual:
($342)
Atlas
of EMG Waveforms - DVDs:
($698)
Needle Exam Anatomy:
($172)
Chemodenervation & Neck and Head Muscles Anatomy:
($422)
Please Note:
TeleEMG.com does not accept credit cards as a method of payment
outside of the U.S. & Canada. Please email us to
info@teleemg.com for payment methods
outside the US and Canada
Credit Card Holder Information:
Name (as it appears on credit
card):__________________________________
Address: ________________________________________________________
_______________________________________________________________
Telephone: ______________________________________________________
FAX:___________________________________________________________
E-Mail: _________________________________________________________
Method of Payment:
Visa
MasterCard
Credit Card #: __________________________________________________
Expiration Date:______/______ (mm/yy)
Check
(Make check payable to TeleEMG and mail to address above)
Authorized Signature: ____________________________________________