LymphBall Order Form Paying by Invoice

LymphBall Order Form

Payment by Invoice only
Name *

Title First Name Last Name
Company Name
(If applicable)
Email *
example@example.com
Contact Phone Number *

Area Code Phone Number
Delivery Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
How did you find out about the LymphBall? *
If "Other" please state
If your therapist informed you, please state their name or the clinic and we can drop them a thank you.
PRICES

Minimum order of 2 LymphBalls

(Round &/ Capsule)
How many round £2.25 each? *
How many capsule £2.50 each? *
Postage and Packing £3.75
Payment by Invoice Only
Invoice

BACS: details can be found on invoice which will be sent to you shortly
Invoice Address if different from above

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Do you have a purchase order number?
Purchase order number
Marketing Communications
Lymphoedema Training Academy, or partners would like to keep you informed of other products or services relating only to your enquiry, If you do not wish to receive info please let us know. (Please note that LTA will however contact you with regards to your order)

YES please keep me informed NO thank you
For further information about how we collect and use your data, please see our Privacy Notice

http://www.lymph.org.uk/privacy-notice/
Thank you for your order!

Please note: Your order will be dispatched once payment has been received.
Should be Empty:

LymphBall Order Form