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ORDER FORM

Fax 1-781-235-3252 or Mail Order if you do not want to order on-line.

Your choice: Order ON-LINE: (via our secure link) by clicking order next to the item you want to purchase (do not forget to check-out) or
PRINT and use this ORDER FORM Call 1-800-549-0095 for questions.

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Name.....:________________________________________________

Address..:________________________________________________

City.....:_____________________________ Phone: ______________

Zip......:__________________State or Country:______________________

Payment by: ___ Check/Money Order enclosed ___ Charge my credit card

___MasterCard ___VISA ___AMEX ___Discover ___Diner's Club

|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|

Exp. Date: _________ Signature: _____________________________

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Please send me: (We can ship to a different address - please indicate)

_____ e-pill Vibrating PILL BOX 4 Daily Alarms. Medication Reminder and pillbox combination ($39.95 includes batteries)

_____ e-pill Multi-Alarm PLUS Easy-to-Set Medication Reminder and Pillbox ($49.95 complete w/ batteries)

_____ e-pill Multi-Alarm HOME Easy-to-Set Medication Reminder Refrigerator Magnet Timer ($49.95 complete w/ batteries)

_____ e-pill CADEX Beep Alarm + Text Message 12 Alarm Wristwatch & Electronic Medication Alert Bracelet ($99.95 /rubber strap. Color: __ Silver __ Black __ Pediatric)

_____ e-pill CADEX LEATHER 12 Alarm Watch. Beep + Text 12 Alarm Watch & Electronic Medication Alert Bracelet ($104.95)

_____ e-pill CADEX CARABINER Beep + Text 12 Alarm Watch & Electronic Medication Alert Bracelet ($109.95)

_____ e-pill CADEX COIL Pocket Watch Beep Alarm + Text Message 12 Alarm Pocket Watch ($109.95)

_____ e-pill MeDose ADULT Vibrating 6 Alarm Watch with Leather band __ Silver / Black | __ BLACK with Black Leather Strap ($99.95)

_____ e-pill MeDose PEDIATRIC Vibrating 6 Alarm Watch w/ Velcro band Red/Blue with Velcro Strap ($99.95)

_____ e-pill Med-Time XL Reminder & Automatic Dispenser complete ($289.95 w/batteries, 2 medication trays, lock w/ key (2), prescription card, manual)

_____ e-pill MedSmart Reminder & Automatic Dispenser with Early Dose Feature. Complete ($489.95 w/ AC adapter, 2 medication trays, lock w/ key (2), docking station, 4 AA batteries, manual)

_____ e-pill MedSmart PLUS Monitored Reminder & Automatic Dispenser with Early Dose Feature. FREE Monitoring Service by Phone, e-mail or Text message included. NO MONTHLY FEES. Complete ($789.95 w/ AC adapter, 2 medication trays, lock w/ key (2), docking station with modem, phone cord, 4 AA batteries, manual)

_____ e-pill CompuMed Reminder & Automatic Dispenser complete ($844.95 with AC adapter, 2 medication trays, lock w/ key (2), back-up batteries, manual)

_____ e-pill 7-Day Organizer & Reminder WORLD's BEST! ($59.95 canvas case, 7 high capacity organizers, electronic reminder

_____ e-pill Timex DAILY Medication Manager ($39.95 w/batteries, 1 Organizer)

_____ e-pill WEEKLY Medication Manager Complete Seven Day System ($54.95 /batteries, 7 Organizers, Holder)

_____ e-pill Key-Chain Interval Timer VISUAL Reminder ($19.95 w/battery)

_____ e-pill PillCheck VitaCarry 7-Alarm Vibrating Pillbox Timer ($45.95)

_____ e-pill 12 Alarm Pager Vibrating Multi-Alarm Reminder (12 Alarms). Carry it in your pocket, purse or on your belt. ($75.95 w/batteries and Belt Clip)

_____ Medical Watch Accessory ($9.95):
__ Pendant kit __ Blue strap __ Red strap __ Diabetes __ Medical Condition __ Brown strap __ Velcro Strap (Black) __ CADEX Original Strap

_____ e-pill (other device) ____________________________________________________________




_____ Mass residents please add 6.25% sales tax.

_____ Shipping and Handling. FREE Standard Shipping (U.S. customers only), Outside US $15.00/order)

_____ ORDER TOTAL .... My Time-Zone: ______ (for FREE set-up)

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MAIL ORDER:e-pill, LLC | DiabetesandTravel.com
49 Walnut Street, Bldg 4
Wellesley, MA 02481-2108, USA
www.MedicalWatches.com or www.epill.com ORDER FAX: Fax: (781) 235-3252 ORDER by PHONE: 1-800-549-0095
Shipping & Handling: FREE Standard Shipping & Handling, Outside US $15.00 / order