AllHeart.com - The Largest Online Store for Medical Professionals Complete Form and Fax or Mail to:
AllHeart
PO BOX 352
Louisiana, MO 63353
fax: (660) 263-1239
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!
If you're not completely satisfied with any merchandise you have received, just return it within 30 days of receipt for a full refund or exchange. (Some exceptions apply.)
Shipping & Handling (see chart below):                    
Order Subtotal:                    
Sales Tax - California Residents Add 9.75%:                            
Missouri Residents Add 7.725%:                            
Duties & Taxes - Canada Residents Add 18%:                            
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 & up =
Smart
Post

$6.99
$8.99
$10.99
$12.99
$14.99
$16.99
$19.99
4.0%
Premium
Ground*

$9.99
$12.99
$14.99
$16.99
$18.99
$20.99
$23.99
5.5%
3-Day
Air

$14.99
$15.99
$18.99
$19.99
$20.99
$22.99
$27.99
6.0%
2-Day
Air**

$19.99
$20.99
$23.99
$24.99
$25.99
$27.99
$32.99
7.0%
Next Day Delivery
$36.99
$37.99
$40.99
$41.99
$42.99
$44.99
$49.99
10.5%
Canada
Taxable 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 =
Canadian
Shipping Rate

$24.99
$29.99
$33.99
$35.99
$39.99
$42.99
$44.99
$70.99
8.0%
Note: There is a $10 surcharge for deliveries to Alaska and Hawaii.

* Premium Ground Service is only available in the 48 contiguous United States. Not available in AK and HI.

** 2-Day Air is not available when shipping to a P.O. Box address. Your order will be delivered on the 2nd Business Day (Business Days are M-F excluding Holidays) after date of order if the order is received by 2:00pm CST.

(Note: The schedule above is ONLY an estimate, not a guarantee. All shipping is out of St. Louis, MO.)

Mexico, Japan, Italy, Netherlands: Add $3 US Dollars per item plus the rate.

All Other Countries: Add $10 US Dollars per item plus the rate.
All Other International
Taxable 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 =
All Other International
Shipping Rate

$22.49
$31.49
$34.49
$41.49
$45.49
$61.49
$68.49
$75.49
$96.49
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.      ©2011 Scrubs AC, Inc. - AllHeart.com®

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