AllHeart.com - The Largest Online Store for Medical Professionals Complete Form and Fax or Mail to:
AllHeart.com
PO Box 6810
Vernon Hills, IL. 60061-6810
fax: (800) 323-2329

Bill To: Ship To:
Name:   Name:  
Address:   Address:  
City:   State:   Zip:   City:   State:   Zip:  
Phone:   Phone:  
e-mail address (needed for order/shipping confirmation):  

item # color size qty. item description price each total price
             
             
             
             
             
             
Satisfaction Guaranteed!
Wear our merchandise for 30 days and if you are not completely satisfied, return it for a full refund. 		Shipping & Handling (see chart below):                    
Order Subtotal:                    
Sales Tax - California Residents Add 7.25%:                            
Ohio Residents Add 6.75%:                            
Gift Certificate Number:                                                                 Subtract Gift Cert. Value:                    
Internal Code: Fax or Mail                                                                 Your Order Total Due:                    

Shipping Method (check one)       __ U.S.A.       __ International
U.S.A. Order Amount
$0.00 to $14.99 =
$15.00 to $25.99 =
$26.00 to $49.99 =
$50.00 to $74.99 =
$75.00 to $99.99 =
$100.00 to $199.99 =
$200.00 to $499.99 =
$500.00 to 749.99 =
$750.00 to 999.99 =
$1000.00 to 1999.99 =
$2000.00 to 2999.99 =
$3000.00 to 3999.99 =
$4000.00 to 4999.99 =
$5000.00 & up = 		U.S.A. Shipping Cost
$6.49
$7.49
$9.49
$11.49
$12.49
$14.49
$17.49
$19.49
$29.49
$59.49
$99.49
$139.49
$179.49
$249.49
Intl. Order Amount
$0.00 to $14.99 =
$15.00 to $49.99 =
$50.00 to $99.99 =
$100.00 to $149.99 =
$150.00 to $199.99 =
$200.00 to $349.99 =
$350.00 to $499.99 =
$500.00 to $999.99 =
$1000.00 up = 		Intl. Shipping Cost
$22.49 (+ $10 per item)
$31.49 (+ $10 per item)
$34.49 (+ $10 per item)
$41.49 (+ $10 per item)
$45.49 (+ $10 per item)
$61.49 (+ $10 per item)
$68.49 (+ $10 per item)
$75.49 (+ $10 per item)
$96.49 (+ $10 per item)

Payment Method. Sorry, no CODs. (check one)
__Check or Money Order (Payable to AllHeart)     __Visa     __Mastercard     __American Express     __Discover
Print Name on Credit Card:  
Credit Card Number:                                                       CID: Expiration Date:  
Signature:   Today's date:  

Please Note: Checks must be drawn from U.S. banks.
©2007 Professional Appearances, Inc. - AllHeart.com®