Earthlite Esquire Stationary
Chiropractic Table $385+S&H TBA PER DELIVERY ADDRESS & SERVICE & INVOICED & PAID PRE-SHIPMENTAdd S&H for all accessories at
the bottom of the form at the bottom of this page.
Feel free to email
us
any time or call us toll free at
866.897.7296 or 206.725.8591 between M-F 9 am and 5 pm
Pacific Time with your questions
or your order.
Color Samples:
Click on swatch to enlarge
black
burgundy
mystic blue
teal
CUSTOMER INFORMATION:
NOTE: All fields marked with an
* are REQUIRED!
First Name *
Last Name *
e-mail address *
Address Line 1 *
Address Line 2 (optional)
City *
State * (TIP: Type the first letter of
your state to jump down the list!)
Zip Code * or
Mail Code* USA or
Other Country
Contact Telephone Number*
PAYMENT INFORMATION:
You can pay for your order with your credit card
OR from your
checking account.
Expiration Date: Name of the card holder as it appears on the credit card (Not the
name of the bank):
(REQUIRED)
If you are paying with a credit card
but you prefer calling this information in rather than submitting it online
via this SECURE ENCRYPTED form, then complete the rest of your order and check
below:
I AM CALLING IN WITH MY PAYMENT INFORMATION!
Call 866-897-7296between 9 AM and 7 PM Pacific Time
to leave your credit card account information. If you reach
our recording, then we are on the phone with another customer. Please
leave your name and phone number and we will call you back when we are
done with the other customer or during our business hours.
Comments/Suggestions:
YOU MUST CLICK ON THE "Send Order" BUTTON TO COMPLETE YOUR PURCHASE! Please click only once!
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