Request a Shipping Quote

Please fill out the form below to request a shipping quote.

International Shipments are air-freighted. Please enter your city and International Airport Code below. Choose "International" for state.

Please fill out the required fields

1. Title *
   Dr. Mr. Mrs. Ms. Miss
2. Name *
3. Email *
4. Phone Number *
5. City *
6. State (Choose "International" if outside the U.S.A.) *
   AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR RI SC SD TN TX UT VA VT WA WI WV WY International
7. Country *
8. US Zip Code or name of closest Internationl Airport *
9. What product model? *
   Please choose one HA90C Table Air-Flex Table A-F-T Automatic Flexion Table Anatomotor Traction Massage REPEX 2 Evolution DT HA90AM - Hi-Lo HA90 (OMT) HA90E Exam Chair HA90MD Exam Chair HA90P Podioatry Chair HA90W Wound Care Chair HA90D Dermatology Chair HA90V Vascular table HA90ALB Aesthetics Chair Counterstrain Table HA90CT Cast Table HA90M Mat Table HA90PT Table Rath Mechanical Table PT Tilt Table Occupational Table HF54 Ultrasound Horizon Light Therapy Aklarus Photo Therapy Other
10. How many? *
    1 2 3 4 5 6 7 8 9 10+
11. Additional Notes
12. How did you hear about us?  
    Internet Search / Website Dealer Magazine Tradeshow Word of Mouth Other
13. Security Code: *
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14.