BK FAX OR MAIL ORDER

Semmes-Weinstein Monofilaments , Clear Vision Reveals^™, Low Temperature Thermoplastic

Timely Neuropathy Testing

BK CLEAR LIGHTED MONOFILAMENTS^™
(COLOR LIGHT ENHANCED ACCURATE & REPLACABLE)
[Bell Krotoski Design, Pat. Pend. All rights reserved]

ORDER FORM FOR FAX OR MAIL/CHECK/PURCHASE ORDER
(print form for fax/mail)

(or ORDER ONLINE)

Fax or mail to:

Timely Neuropathy Testing
9553 Island Rd
Ventress, LA 70783 Fax 1 800 755 5102

Prices 2009 EXCESS INVENTORY CLEARANCE SALE

Monofilament Sets SKU # Price Quantity Total

BK CLEAR LIGHTED Monofilaments^™

[HAND/BODY/ and plantar FOOT]
Screen and Monitoring
Set of 6
(includes one interchangeable Light
Attachment)

BK CCHFB

~~$129.99~~sale $109.99

BK CLEAR LIGHTED Monofilaments^™

[HAND/BODY] Screen and Monitoring
Set of 5
(includes one interchangeable Light Attachment)

BK
CCHBX

~~$99.99~~sale $79.99

BK CLEAR LIGHTED Monofilaments^™

[HAND/BODY/FOOT]
Screen and Monitoring
Set of 20
(includes one interchangeable Light
Attachment)

BK CCHFB20

~~$249.99~~ sale $199.99

BK CLEAR LIGHTED Monofilaments^™

Loss of Protective Sensation [HAND/BODY and plantar FOOT]
Set of 2
(includes one interchangeable Light Attachment)

BK
CCHFP

~~$49.99~~sale $39.99

BK CLEAR LIGHTED Monofilament^™

Within Normal Limits [HAND BODY and dorsum of FOOT]
Set of 2
(includes one interchangeable Light Attachment)

BK
CCHFN

~~$49.99~~sale $39.99

Individual Filaments SKU # Price Quantity Total

Light Attachment (monofilaments are interchangable)

BK LA

$24.99

Individual Sizes

BK CLEAR LIGHTED Monofilament^™ 2.83 50mg levelNormal [HAND]

BK IT1

~~$24.99~~sale $19.99

BK CLEAR LIGHTED Monofilament^™ 3.61 200mg level
[Normal plantar FOOT]

BK IT2

~~$24.99~~sale $19.99

BK CLEAR LIGHTED Monofilament^™ 4.31 2g level

BK IT3

~~$24.99~~sale $19.99

BK CLEAR LIGHTED Monofilament^™ 4.56 4g level

BK IT4

~~$24.99~~sale $19.99

BK CLEAR LIGHTED Monofilament^™ 5.07 10g level
[Protective plantar FOOT]

BK IT6

~~$24.99~~sale $19.99

BK CLEAR LIGHTED Monofilament^™ 6.65 300g level

BK IT5

~~$24.99~~sale $19.99

Subtotal p1, plus subtotal p2, plus subtotal p3 ________________

Shipping and Handling ________________

Subtotal plus Shipping and Handling ________________

Sales tax LA 8.5 % ________________

TOTAL DUE ________________

Purchase Order Number _________________(attach authorization)

Check Number___________________(payable to Timely Neuropathy Testing)

Shipping and Handling (For orders less the $50. add $5.00, for orders more than $50. add 10 percent (for orders outside continental US contact us for shipping and handling)

BILL TO SHIP TO (if different from billing address)

Name_____________________________ Name___________________________

Company__________________________ Company_________________________

Address___________________________ Address__________________________

City_____________State____ZIP______ City____________State____ZIP______

Phone Number_____________________ Phone Number_____________________

Email_______________________________

THANKS FOR YOUR ORDER!

(for internal use Received________________ Process Date_____________________)

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Timely Neuropathy Testing

ORDER FORM FOR FAX OR MAIL/CHECK/PURCHASE ORDER (print form for fax/mail)

BILL TO SHIP TO (if different from billing address)

Send mail to timelyneuropathytesting.com with questions or comments about this web site. Copyright © 2006 Timely Neuropathy Testing Last modified: May 20, 2008

ORDER FORM FOR FAX OR MAIL/CHECK/PURCHASE ORDER
(print form for fax/mail)

Send mail to timelyneuropathytesting.com with questions or comments about this web site.
Copyright © 2006 Timely Neuropathy Testing
Last modified: May 20, 2008