INNERSENSE, INC.
PURCHASE AGREEMENT - ORDER FORM
|
Date: |
|
|
Customer: |
|
||
|
Address: |
|
||
|
|
|
||
|
|
|
||
|
Phone: |
|
FAX: |
|
PRODUCT DESCRIPTION |
UNITS EA. |
PRICE EA. |
TOTAL COST |
| VIBRASOUND® WAVE TABLE | $13,500.00 |
||
| VIBRASOUND® ZERO GRAVITY CHAIR | 3995.00 |
||
| VIBRASOUND® MASSAGE TABLE | 2995.00 |
||
| SENSORIUM™ LSV SENSORY INTERFACE | 695.00 |
||
| ABSOLUTE SCALE OF RELATIVE COSMIC REALITY™ | 300.00 |
||
| HARMONIC LAW™: THE SCIENCE OF VIBRATION (CD ONLY) | 75.00 |
||
| GREAT DIESIS™ HARMONIC REINFORCEMENT CDs: | SEE BELOW |
||
| PURE WHITE SOUND (68 MINUTES) | 33.00 |
||
| PURE PINK SOUND (68 MINUTES) | 33.00 |
||
| PURE BREATH (68 MINUTES) | 33.00 |
||
| PURE RAIN (68 MINUTES) | 33.00 |
||
| PURE SLEEP (68 MINUTES) | 33.00 |
||
| PURE ASCENSION (68 MINUTES) | 33.00 |
||
| PURE DESCENSION (68 MINUTES) | 33.00 |
||
| HARMONIC REINFORCEMENT SET (ALL SEVEN CDS) | 200.00 |
||
| GDCD SAMPLER (10 MIN EACH ALL SEVEN SOUNDS) | 33.00 |
||
| TRANSFORMANT™ ALLASSO CONCENRATE (50 ml.) | 65.00 |
||
| TRANSFORMANT™ CONCENRATE CUSTOMIZED (50 ml.) | 85.00 |
||
| VIBRASOUND VR LSV DOME - SENSORIUM | CALL FOR PRICE |
||
| CALIFORNIA SALES TAX (8.25%) | |||
| SHIPPING AND HANDLING (CALL FOR PRICE) | |||
| TOTAL SALE | |||
| DEPOSIT | |||
| BALANCE DUE |
Card Number, Expiration Date and 3 Digit Code on Back of Card in Sign Line
|
|
Name as shown on card:
|
|
Address Associated with card account (if different than above):
|
|
|
|
Customer here by authorizes InnerSense, Inc. to charge the "Total Sale" amount as indicated on this form. InnerSense, Inc. accepts no
returns on these items. Credit is limited to repair or replacement of damaged merchandise only. Call for return authorizations for
damaged goods. All products are warranted for a period of one year from purchase.
Accepted by (customer signature): _________________________________Date: ______________
Customer: Please fill in, sign, and fax this form to (310) 829-9784 or mail to 2118 Wilshire Blvd. #730, Santa Monica, CA. 90043.