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| Print and Fill Out Form and
circle or check options. |
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Name: |
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Phone # |
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Date |
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Brand of hearing aid |
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Circle |
Left or
Right or Both |
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Address: |
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What's wrong with the
hearing aid? |
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Dead |
Weak |
Other (briefly explain) |
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Static |
Distorted |
Intermittent |
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Hearing Aid Repair
Services |
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6 month warranty $115 each |
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1 year warranty $39.95 extra each |
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24 hrs Rush Orders
$20 |
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40 Batteries size 13 312
10 675 $27 |
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Shipping Methods |
US Postal Service |
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First
Class Priority 2-3 days Next Day Mail |
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Free $12.00 $22.00 |
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Payment
with Order |
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Credit
Card
Checks Money
Orders |
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Visa or Master Card No delay on
check orders |
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Fill in the information below for Credit
Card Orders |
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Credit Card # |
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Exprartion Date: |
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Street address for billing of credit card( if not
the same as above). |
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E.R. Hearing
Aid Repair |
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102 E.
Olive St |
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Lansing, KS
66043 |
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1-800-976-0601 |
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www.erhearingaidrepair.com |
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Click here to go to the home page |
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| Shipping
to Canada add 7 dollars to the order. |
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| If you lik cut out our address and tape it
to the package. |
Cut out the address and tape it to the package if you like. |
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