The Phipps & Bird Portable Dialysate Warmer TM
for Continuous Ambulatory Peritoneal Dialysis Patients
This is NOT an electronic form. Because of credit card security we have created a printable form only. Please print out the form below, fill in the following fields, and either fax or mail it to Phipps & Bird. Thank you.
1519 Summit Avenue,
Richmond, Virginia 23230
Phone: 804-254-2737
or toll free: 800-955-7621 (USA)
Fax: 804-254-2955
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Price $429 + (5.3% VA Sales Tax) = (Total)
Color Choice: Navy
Payment Method (check one):
Check or Money Order. Enclose check or money order, made payable to Phipps & Bird, for $429 (Virginia residents add 5.3% state sales tax). Shipping charges are included (Continental U.S.A. only).
Credit Card (check one): VISA MasterCard American Express
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If you know someone who would like to order the P&B Portable Dialysate Warmer, please feel free to print off and give them a copy of this order form, or call us at 1-800-955-7621 for additional brochures and forms.