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--DiscoverThis 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 LastShip To Address Street and number City, State, ZipTelephone (with area code)E-mailName of person on Credit CardCredit 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)
How many Siemens Phoenix 313 "Power" 100% Digital Aids would you like? >>>01234(Total cost for each aid $475.00) $23.75 return fee to return aidShipping Options - SHIPPING OPTIONS-----(CLICK HERE)--->>> FREE GROUND SHIPPING FREE PRIORITY MAIL FOR BUYING TWO AIDS SECOND DAY AIR $25.00 FED-X NEXT DAY EXPRESS $50.00 Over Seas Shipping=15% of Total
I have been advised by Heareasy Hearing Aids that the Food and Drug Administration (FDA) has determined that my best interest would be served if I had a medical evaluation by a licensed physician (preferably a physician who specializes in diseases of the ear) before purchasing a hearing aid. (See FDA info on home page) I am 18 years of age or older and I do not wish to have a medical examination before purchasing a hearing aid from Heareasy Hearing Aids.Click on the arrow below to sign the waiverClick Here to Sign this Order >>>>>>>>>>>>>>>>I want to buy this hearing aid before seeing a Doctor.I am sending the medical clearance by fax<<Click Here
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