SONAFON Order Form:


By VISA____ or Master Card____:


Name on the credit card:

Credit Card Number: Exp.date:

Name to ship to:

Street Address: Suite No.

City: State/Prov.:

Zip/Postal Code: Telephone: Email Address:

Date: Comments:

Number of SONAFONs to order:    Price $:    +Shipping $:  Sum $:

+5% GST (Canada only) $:  +8% PST (Ontario only)   Total Amount $:

We thank you for the order!

NOTE: Please print and mail in the Order Form to the following Address:

Electro Medica Office
3395 Cliff Rd.N.unit 102
Mississauga. ON,
L5A 3M7

Your SONAFON(s) will be shipped within a week, upon receipt of your Payment, by insured parcel post.