ORDER FORMFax 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 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 Multi-Alarm POCKET Easy-to-Set Medication Reminder ($39.95 complete pocket pouch includes batteries) _____ e-pill Multi-Alarm PLUS Easy-to-Set Medication Reminder and Pillbox ($49.95 complete w/ batteries) _____ e-pill Multi-Alarm HOME Easy-to-Set Medication Reminder Refrigerator Magnet Timer ($49.95 complete w/ batteries) _____ e-pill CADEX Beep Alarm + Text Message 12 Alarm Wristwatch & Electronic Medication Alert Bracelet ($79.95 /rubber strap. Color: __ Silver __ Black) _____ e-pill CADEX LEATHER 12 Alarm Watch. Beep + Text 12 Alarm Watch & Electronic Medication Alert Bracelet ($84.95) _____ e-pill CADEX CARABINER Beep + Text 12 Alarm Watch & Electronic Medication Alert Bracelet ($89.95) _____ e-pill CADEX COIL Pocket Watch Beep Alarm + Text Message 12 Alarm POcket Watch ($89.95) _____ e-pill MEDGlider Organizer & 4 Alarm Reminder complete ($45.95 Reminder w/batteries, 7 organizers and Tray) _____ e-pill MeDose Vibrating 6 Alarm Watch with Leather band Silver / Black with Black Leather Strap ($99.95) _____ e-pill MeDose Pediatric Vibrating 6 Alarm Watch w/ Velcro band Red/Blue with Velcro Strap ($99.95) _____ e-pill Med-Time XL Reminder & Automatic Dispenser complete ($289.95 w/batteries, 2 medication trays, lock w/ key (2), prescription card, manual) _____ e-pill 7-Day Organizer & Reminder WORLD's BEST! ($59.95 canvas case, 7 high capacity organizers, electronic reminder _____ e-pill Pill Reminder Fob with Tiffany-Style Sterling Silver Key-Ring ($39.95 w/batteries) _____ e-pill Timex Medication Manager ($24.95 w/batteries) _____ e-pill Pill Bottle Multi Alarm (49.95 for 3 units) _____ e-pill Key-Chain 6-Alarm Reminder (TWO for $39.95 w/batteries) _____ e-pill PillCheck VitaCarry 7-Alarm Vibrating Pillbox Timer($45.95) _____ 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 MD.2 Monitored Automatic Pill Dispenser complete ($744.95 incl. 60 days free monitoring, complete system incl. cups (100), keys (2), loading tray) _____ Watch Accessory ($9.95): __ Pendant kit __ Blue strap __ Red strap __ Diabetes __ Medical Condition __ Brown strap __ Velcro Strap (Black) __ CADEX Original 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 ($239.00 complete w cord, AC adapter, manual, main unit, 2 pendants w/ batteries) _____ e-pill (other device) ____________________________________________________________ _____ Mass residents please add 5% sales tax. _____ Shipping and Handling (FREE Standard Shipping ( U.S. customers only), Outside US $15.00/order) _____ ORDER TOTAL .... My Time-Zone: ______ (for FREE set-up) MAIL ORDERS: e-pillŪ Medication Reminders 70 Walnut Street Wellesley, MA 02481, USA http://www.epill.com Shipping & Handling: FREE in the US by Standard Shipping, Outside US $15.00/order |
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