BELL SECURE ORDER PAGE

Heareasy Secure Order Form

Please fill out each line in the spaces below. You will be submitting this information directly to our order department. This is the fastest way to order Hearing Aids. All orders will be shipped Monday through Friday.  All orders from this order form will ship within 48 hours from time received. You may chose the method of shipping below. 

Master Card--Visa--Discover
This site is secure but if you want, we can call you back to get your Credit Card Number. 
You will still need to fill out the rest of the form and submit it to us to order.

Name/           First                            Last

Ship To Address     
Street and number  

City, State, Zip

Telephone (with area code)

E-mail

Name of person on Credit Card

Credit Card #      
If you would like a call back for your Credit Card Number, Click on check box
 
Expiration Date
  Security Code on back of card (Last 3 Digits)

Zip Code for the credit card if address is different than shipping
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Click the dropdown box to select your model

Select right, left or both ears >>>

Enter Coupon code here >>> Your discount will be deducted automatically when we run your card
 


Shipping Options -  

Return fee is 7% of the cost of each aid

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