ORDER YOUR EQUIPMENT FROM R~WAVE

Please complete the order form below and an R~Wave
sales representative will contact you. Please have a major credit card ready to complete the transaction.

 

   Facility Name:
   First Name:
   Last Name:
   Address:
   City:
   State:      Zip:
   Email:
   Telephone: ext.:
   Fax:

 

  

How did you hear about us?:

  

 

Referral from:
Direct Mail
Fax Advertisement

Advertisement:
EMS
JEMS
Medical Equipment
Plastic Surgery
Medical Dealer


Other Advertisement:

 

What accessories do you need?
 

 Patient Cable
 Battery Charger
 Operator Manual
 Power Cord
 Trays
 Pacing Cables
 Hands Free Adapter
 Service Manual
 Finger Probe
 Internal Paddles
 Pacing Cassette
 Carrying Case
 Batteries
Paper    

Other Accessories:

 

Comments:

 


 

 

 

 

 


 

 

       

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