Independent Living Aids Order Form (2017)
Bill To: Ship To: (if different from billing address)
Name: ______Name: ______
Tel # ______Tel # ______
Address: ______Address: ______
______
Apt #: ______City: ______Apt #: ______City: ______
State/Zip Code: ______State/Zip Code: ______
Circle one: VISA, MC, AMEX, DISCOVER, Check, Money Order
Credit Card #______My Card Expires: ______
Signature: ______
Qty / Item # /Description
/ Price / Ext PriceMail to: Independent Living Aids Shipping & Handling: ______
137 Rano Street NY State residents add 8.75 % Sales Tax
Buffalo, NY 14207 Including tax on shipping charges:______800-537-2118 Fax: 855-937-3906 Grand Total: ______
Return Policy: Items returned within 60 days in like-new condition and in original packaging will be refunded or exchanged, excluding shipping and handling. When a manufacturer's restocking fee is indicated next to an item, it will be deducted from the refund. Because of health department regulations we cannot accept returns of items that have been used on or in the body. This includes but is NOT limited to items such as thermometers, eye-care and ear-care products, diabetic aids, ointments, creams, manicuring aids, eye drops, urinals, etc. Please contact customer service for further clarification. Computer software is not returnable. ILA reserves the right to substitute equal or better products when the photographed item is not available.
2017 Independent Living Aids, LLC Shipping Charge Chart for order that are mailed in or called into our Customer Service Department at 1-800-537-2118
SHIPPING & HANDLING CHARGESPurchase Amount / S/H Charge
$0.01 to $24.99 / $7.50
$25.00 to $49.99 / $8.95
$50.00 to $99.99 / $11.95
$100.00 to $199.99 / $14.95
$200.00 to $299.99 / $18.95
$300.00 to $499.99 / $21.95
$500.00+ add $7.50 / for each add’l $500.00
*PLEASE NOTE:
NEW YORK Residents add 8.75% Sales Tax, including tax on shipping and processing charges.