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Please note:

  • If you will be submitting your order on a purchase order, you will NOT be using this form.
  • IMPORTANT! We invoice as "Innovative Medical Marketing of VA". When you prepare your check (if you will be paying by check), please make check payable to "Innovative Medical Marketing of VA". If your organization is tax exempt, please fax or email us a copy of your tax exempt certificate and please be sure to reference any order recently placed. Virginia residents, we will add 5% sales tax on final invoice total if not exempt.

A. SHIPPING AND BILLING ADDRESS

Shipping Address Billing Address

B. CONTACT INFORMATION

C. PREFERRED METHOD OF PAYMENT

Read each option below (1, 2 or 3), and check one box only.

NOTE: Orders are processed (reviewed and logged into our system) upon receipt, however, we cannot guarantee an exact date your order will ship. With the exception of backorders, special orders and option 1 (below), we make every effort to ship orders within 1-3 business days of being received, however, this is not a guarantee and orders can take longer to fill depending on the time of year, etc. In addition, this does not include the time it takes for the carrier (UPS) to deliver the items to you. If you need your order by a particular date, please contact our customer service department at (757)-645-9369 and we will make every effort to accommodate your needs.

(1) Invoice me and I will PRE-PAY by check. (PLEASE NOTE: Your order will be processed immediately, however, we will await the arrival and clearance of your check before shipping your order (once your check has cleared, your order will ship within approximately 1-3 business days). If you would prefer that your order is shipped before the arrival and clearance of your check, select option 2 or 3.

(2) Invoice me and use my credit card as collateral until you receive my check – my order will be processed immediately and will ship within approximately 1-3 business days. I understand that my credit card will be authorized to show there is sufficient funding to cover the final invoice total, before my order is sent out. (Authorization is NOT a charge to your credit card.) I further understand that if you do not receive my check within 30 days of the invoice date, my credit card will be charged for the entire amount on the invoice including shipping and handling charges. Please fill out credit card information below (Visa or MasterCard only).

(3) Paying by credit card (VISA, MasterCard, Discover only). (Your order will be processed immediately and will ship within approximately 1-3 business days.) Credit orders over $500.00 subject to 2% service charge. PLEASE NOTE: YOUR CREDIT CARD IS NOT PROCESSED WHEN YOU CLICK THE "SUBMIT" BUTTON TO SUBMIT YOUR ORDER. YOUR CREDIT CARD WILL BE PROCESSED AT THE TIME YOUR ORDER IS PACKAGED. PLEASE BE AWARE THAT WE WILL ATTEMPT TO CONTACT YOU VIA EMAIL OR PHONE IF THERE IS A PROBLEM PROCESSING YOUR CREDIT CARD.

 

If you selected payment option 2 or 3, please provide credit card information below.

D. YOUR ORDER

INSTRUCTIONS: The items in this section are broken-down into product groupings, i.e. the piCO+ and all the accessories that go with the piCO+ are listed in the "piCO Product Line" grouping. Whether you are ordering product for the first time or simply re-ordering additional accessories, please order what you need under your product's grouping, i.e. if you have a piCO+ and are ordering cardboard disposable mouthpieces, go to the "piCO Product Line" grouping to order these Not every product/accessory that we carry is listed on our website. If you are ordering a product that is not listed, please enter it in the last grouping in this section titled "Other". Please indicate the number of items desired in the space provided. ONLY edit price if quoted price differs from price listed.

NOTE: Prices do not include shipping and handling charges which will be added at the time of invoicing and packing.

MONITORS

Product

Model

Quantity

Price
Micro+ Micro+ $1,225.00
piCO+ piCO+ADV $688.00
ToxCO+ Kit EC50-TOXCO-Kit-V $1,950.00
ToxCO+ EC50-ToxCO+-V $1,650.00
CompactUSB CompactUSB $265.00
Baby Compact Baby Compact $115.00
TM3 Monitor for Methyl romide TM3-MBD-V $2,475.00
EC80 Phosphine Gas Monitor EC80-V $2,050.75
PhoxAir Personal Phosphine Detector PhoxAir $1,975.00
NOxBOx Plus NO and NO2 Monitor NOxBOx-Plus $8,050.00
Finger pulse oximeter Oximeter $100.00
Finger pulse oximeter – child Oximeter Ped $100.00

 

ACCESSORIES

Product

Model

Quantity

Price
Flatpak mouthpieces (box of 250) FP-MP/250 $42.00
D-piece for flatpak mouthpiece, set of 12 D-piece $103.00
D-piece for flatpak mouthpiece, set of 6 D-piece-6 $60.00
Flatpak T-piece, set of 10 FP/T-piece $103.00
Flatpak T-piece, set of 5 FP/T-piece-5 $60.00
Disposable cardboard mouthpieces (box of 200) EC50-MP $35.00
Calibag for 20 ppm CO in air CALI-BAG/20 $60.00
Calibag for 50 ppm CO in air CALI-BAG/50 $60.00
50 ppm 34-liter CO Calibration kit CO-CALIB-34-50 $252.00
20 ppm 34-liter CO Calibration kit CO-CALIB-34-20 $198.00
50 ppm 34-liter CO Replacement can CO-CAN-34-50 $125.00
20 ppm 34-liter CO Replacement can CO-CAN-34-20 $98.00
34-Liter Hydrogen calibration kit EC60-CALIB-34 $295.00
34-Liter Hydrogen replacement can EC60-CAN-34 $135.00
COData+/Gastrochart Software BEDSOFT $95.00
CO Maternity Pack COM $25.00
LungLife Disposable Mouthpieces (box of 200) SPIRMP $65.00
Alcohol-free cleansing wipes for monitor – pack of 25 Wipe-BB $17.50
Calibration Adaptor EC50-CA-V $16.00

E. SHIPPING METHOD SELECTION

FOR U.S CUSTOMERS ONLY – IF THIS SECTION IS LEFT BLANK, YOUR ORDER WILL BE SHIPPED VIA UPS GROUND SERVICE OR IF GROUND SERVICE IS NOT AVAILABLE, VIA UPS SECOND DAY AIR. SELECT THE PREFERRED SHIPPING METHOD BELOW.

PLEASE NOTE:Orders are processed (reviewed and logged into our system) upon receipt, however, we cannot guarantee an exact date your order will ship. With the exception of backorders, special orders and payment option 1, orders ship from our facility within 1-3 business days of being received, however, this is not a guarantee and orders can take longer to fill depending on the time of year, etc. In addition, this does not include the time it takes for the carrier (UPS) to deliver the items to you.

UPS GROUND * UPS 3-DAY SELECT** UPS 2nd DAY AIR*** UPS NEXT DAY AIR

SHIPPING AND HANDLING INFORMATION

*All orders for U.S. customers located in the continental, contiguous United States are shipped via UPS Ground service as the standard method of shipping unless an alternate method is requested by customer, or circumstances require an alternate method of shipping be used.

** UPS 3-Day Select service is a ground service, but is classified the same as air service for dimensional weight and hazardous materials charges.

*** Orders for U.S. customers outside the continental, contiguous United States (i.e. Hawaii, Alaska, and Puerto Rico) are shipped via best and least expensive method available, unless an alternate method is requested by customer.

Orders for non-U.S. customers are shipped via the best and least expensive method available. The carrier selected for non-U.S. shipments may vary with every shipment depending on the rate offered. These rates must be quoted.

F. INSTRUCTIONS/COMMENTS

If you have any special instructions or comments, please use the space provided to the right.

 

SERVICE/REPAIR/EVALUATION

If you have sent your monitor in for service/repair/evaluation and have been advised of a charge, please check one of the two check boxes below. A IMMVA representative will advise you of the charges (by phone or email) that you are responsible for, which will allow you to check one of the boxes below. There is no place on this form for you to list the actual charge – You will receive an invoice from us detailing all of the final charges. Please be sure to complete sections A, B, C, and E. You can use section F if you have any special instructions, etc.

Service/Repair/Evaluation Charge

Please check this box if you have been advised of a charge for the service/repair/evaluation of your monitor. Shipping and handling charges are not included in service/repair/evaluation charges and will be added to your invoice. The charges that you will be responsible for will be detailed for you by a IMMVA representative. An invoice with all the charges will be emailed and/or mailed to the address in the Billing address in section A. Please be sure to complete sections A, B, C, and E.
Shipping and handling Charge Only

Please check this box if you have been advised that you are only responsible for shipping and handling charges. An invoice with the charges will be emailed and/or mailed to the address in the Billing address in section A. Please be sure to complete sections A, B, C, and E.

*By submitting your order you authorize the listed charges as well as the all necessary shipping and handling charges and tax if applicable. (If you are tax exempt or located outside of the State of Virginia, we will not charge tax on your order.)

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