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Chiropractic Systems and Key Tag Order Form
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Unit Price
Order
Cost
All-In-One Computer + 17 " Touch Screen
$1,595
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10
All-In-One Computer + 19 " Touch Screen
$1,695
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9
10
19" Touch Screen Monitor Only
$670
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Use customized key tag to expedite patient check-in and to keep a handy reminder about your service
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$238
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Key tags
Pricing
Select
2,500
5,000
7,500
10,000
12,500
Customer will receive a proof prior to job being run. Once signature is received on proof, allow 3-4 week lead time.
Total
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Same as above
Name
Address
City
Select State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakotama
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip
Phone
Fax
Email
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