OrderForm

To Place Orders - Enter Store Front Here

PLEASE, "ORDER NOW!!"

Fill out this Form, Click the Print Button on your browser menu, and Fax (or mail) the signed form to us immediately!

Name:
Address: (required)
Address: (required)
City:
State/Zip Code:
Phone:
Fax:
E-mail (required):
INSTRUCTIONS:Fill in the ITEM NUMBER and DESCRIPTION for each item being ordered. Indicate the Quantity desired (be sure to remember friends!). Enter the PRICE per item. Multiply the Price per Item times the Quantity ordered of each item. Total each horizontal line (each Item's PRICE, times the QUANTITY ordered). Repeat for each item ordered. ADD UP ALL Prices in the Total column to determine the U.S. Dollar Total for your order. Please add sales tax (NV residents only). Please fill out all information regarding NAME, ADDRESS and E-MAIL ADDRESS. You may pay by PERSONAL CHECK, MONEY ORDER, or US CASH (send cash via registered mail only). WE WELCOME YOUR VISA OR MASTERCARD! SIGN where indicated. Please allow 2-4 weeks for delivery. All prices are in U.S. Dollars.

DESCRIPTION / ITEM STOCK NUMBER	QTY	PRICE $	QTY x PRICE (TOTAL)












Subtotal
Shipping (Shipping Cost Page Here)
NV state tax (applies to orders shipped to Nevada Addresses only)
Total Due

PAYMENT METHOD:	CHECK __	MONEY ORDER __	CASH __
CREDIT CARD:	VISA __	MASTERCARD __	DISCOVER __
ACCOUNT NUMBER: ___________________________ 3 DIGIT SIGNATURE CODE (FOUND ON BACK OF CARD FOR ELECTRONIC TRANSACTIONS) _______			EXPIRATION DATE ___/___

By submitting this order form I am affirming, that to the best of my knowledge, any and all items which I am ordering via this order form are legal to purchase, own, and possess in my country, state, and / or community. I generally and specifically hereby release and absolve UNIQUE MEDICAL PRODUCTS, LLC, from any and all liability arising from any product's unsafe or improper use by me or anyone else whom I may direct in anyway whatsoever. I affirm that I am a private citizen and acting in no capacity whatsoever other than as a private citizen in requesting that UNIQUE MEDICAL PRODUCTS ship medical products to me. I promise that all the forgoing statements are true and correct and I affirm that I expect UNIQUE MEDICAL PRODUCTS to rely one the truthfulness of each and ever attestation within this form before shipping medical products to me. (We cannot ship without signature). THANK YOU FROM ALL THE STAFF AT UNIQUE MEDICAL PRODUCTS. WE APPRECIATE YOUR BUSINESS!

X__________________________________________Date_________________________

Click the print button on your browser menu after filling out this form. Surface mail orders to: Charles E Andersen 3804 Warm Meadows Street Las Vegas, NV. 89129! PLEASE REMEMBER YOU MUST MAKE YOUR MONEY ORDER PAYABLE TO: CHARLES E ANDERSEN - IF YOU MAKE IT PAYABLE TO ANY OTHER PAYEE IN ANY WAY WHATSOEVER - MY BANK WILL NOT ACCEPT THE CHECK OR MONEY ORDER FOR DEPOSIT AND I WILL HAVE TO RETURN IT TO YOU FOR CORRECTION - ORDER DELAYED! Your products will be on their way to you within 7 days of receipt of your order and payment!

©2000 - 2009 by Unique Medical Toys, LLC., UniqueMedicaltoys.com & Charles E Andersen, Esquire. All Right Reserved. No text or images appearing on any page or pages or parts thereof constituting this web site may be copied, stored electronically or otherwise used, reused, transmitted, retransmitted or reproduced in any manner whatsoever, without the prior express written permission of Charles E. Andersen. UniqueMedicaltoys.com, UniqueMedicaltoys, and Unique Medical Toys are ™®©Charles E. Andersen 2009. All rights reserved.