Autoclave / Sterilizer / Parts / Accessories Order Form

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Medical

Your Sterilizer and Autoclave Experts                                    Autoclaves and Sterilizers Alfa Medical  59 Madison Ave, Hempstead, NY 11550 1-800-801-9934    fax 516-489-9364

Last name ________________First_____________Company (if applicable)_______________________

Address__________________________________________________

City____________________________State_____ Zip_____________

Tel #__________________Fax#_________________Email_________

What kind of sterilizer do you have now?__________________________
Please circle type of practice :
DDS - MD - DVM - Tattoo - Body Piercer - Lab - Hospital - Dealer - Nursing Home - Other (specify)
 
 

Part #	Quantity	Description	Cost	Sub total
__________________	__________________	__________________	__________________	__________________
__________________	__________________	__________________	__________________	__________________

 

*  Freight for sterilizers For North America Specify [  ] $195.00 Priority overnight      or [  ] $65.00 regular ground.  *  International parts freight $65.00.   *  International freight for Cox Sterilizer is $197.00.

Freight _________________  Total Cost _______________

Please sign _______________________________________________
 

MC [   ]

VISA [   ]

Amex [   ]

Discover [   ]

  card #_______________________________________ exp ____/____
Please write here the 800 # of the bank which is on the back of the credit card -   1-800-______-_______

We'll ship only to the billing address of the credit card holder.

You may also wire the money to Bank of America C/O Alfa Medical ABA 026009593 acct# 1224 00 483 796 1224 Swift Code: BOFAUS3N (there is $40.00 additional bank fees for wire transfere)