FALL 2015 UNECOM

MEDICAL EqUIPMENT STUDENT ORDER FORM

Students Mailing Address:
Name: ____________________________________________________________________________________________________
Address: __________________________________________________________________________________________________
City: ____________________________________________________ State: ______________ Zip: _____________________
Phone (Day): ______________________________________________________________________________________________
Email: ____________________________________________________________________________________________________

Complete Kit Contents:

Littmann Cardiology III Stethoscope Black 27"
McCoy Accura Sphygmomanometer Black
McCoy Tuning Fork C512 Frequency
McCoyTuning Fork C128 Frequency
McCoy Orange Taylor Percussion Hammer
Professional Case Multi Pocket Medical Bag Black
Pocket Eye Chart
Welch Allyn Diagnostic Kit
Exam Gown

Special Kit Price: $968.44

Please fill out this order form and mail along with payment to:
University of New England Bookstore
11 Hills Beach Road
Biddeford, ME 04005

Method of Payment

Check / Money Order

MC

VISA Am. Ex. Discover

(Payable to: University of New England Bookstore)

Card # :_________________________________________________________ Expiration Date: _________________________
Billing Zip Code: _________________________________ 3 Digit Security Code: ____________________________________
Printed Name ___________________________________________ Signature _____________________________________________

University of New England Bookstore

11 Hills Beach Road Biddeford, ME 04005
207-282-3025 Fax: 207-282-3346 e-mail: cheryl-woolley@une.edu