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 Name.....:________________________________________________ Address..:________________________________________________ City.....:_____________________________ Phone: ______________ Zip......:__________________State or Country:______________________ Payment by: ___ Check/Money Order enclosed ___ Charge my credit card ___MasterCard ___VISA ___AMEX ___Discover |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__| Exp. Date: _________ Signature: _____________________________ Please send me: (We can ship to a different address - please indicate) _____ e-pill Vibrating PILL BOX 4 Daily Alarms. Medication Reminder and pillbox combination ($39.95 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 ($99.95 /rubber strap. Color: __ Silver __ Black __ Pediatric) _____ e-pill CADEX LEATHER 12 Alarm Watch. Beep + Text 12 Alarm Watch & Electronic Medication Alert Bracelet ($104.95) _____ e-pill CADEX CARABINER Beep + Text 12 Alarm Watch & Electronic Medication Alert Bracelet ($109.95) _____ e-pill CADEX COIL Pocket Watch Beep Alarm + Text Message 12 Alarm Pocket Watch ($109.95) _____ e-pill MeDose ADULT Vibrating 6 Alarm Watch with Leather band __ Silver / Black | __ 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 MedSmart Reminder & Automatic Dispenser with Early Dose Feature. Complete ($489.95 w/ AC adapter, 2 medication trays, lock w/ key (2), docking station, 4 AA batteries, manual) _____ e-pill MedSmart PLUS Monitored Reminder & Automatic Dispenser with Early Dose Feature. FREE Monitoring Service by Phone, e-mail or Text message included. NO MONTHLY FEES. Complete ($789.95 w/ AC adapter, 2 medication trays, lock w/ key (2), docking station with modem, phone cord, 4 AA batteries, manual) _____ e-pill CompuMed Reminder & Automatic Dispenser complete ($844.95 with AC adapter, 2 medication trays, lock w/ key (2), back-up batteries, manual) _____ e-pill 7-Day Organizer & Reminder WORLD's BEST! ($59.95 canvas case, 7 high capacity organizers, electronic reminder _____ e-pill Timex DAILY Medication Manager ($39.95 w/batteries, 1 Organizer) _____ e-pill WEEKLY Medication Manager Complete Seven Day System ($54.95 /batteries, 7 Organizers, Holder) _____ e-pill Key-Chain Interval Timer VISUAL Reminder ($19.95 w/battery) _____ PuffMinder Inhaler Interval Timer VISUAL Reminder ($19.95 w/battery) _____ 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 12 Alarm Pager Vibrating Multi-Alarm Reminder (12 Alarms). Carry it in your pocket, purse or on your belt. ($75.95 w/batteries and Belt Clip) _____ Watch Accessory ($9.95): __ Pendant kit __ Blue strap __ Red strap __ Diabetes __ Medical Condition __ Brown strap __ Velcro Strap (Black) __ CADEX Original Strap _____ e-pill Medical Alert (No Monthly Fees) PERS Help-At-Hand Model 911 ($239.00 complete w cord, AC adapter, manual, main unit, 2 pendants (activators) with batteries) _____ e-pill (other device) ____________________________________________________________ _____ Mass residents please add 6.25% 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 49 Walnut Street, Bldg. 4 Wellesley, MA 02481, USA http://www.epill.com (International orders +1 781-239-2941) Shipping & Handling: FREE in the US by Standard Shipping, Outside US $15.00/order |
Please fax purchase orders to 781-235-3252. Copyright 2000-09, 2010, 2011 e-pill, LLC | Prices subject to change without notice | 111125 |