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Join The Battery Club On

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The Battery Club is an opportunity for our patients to receive a one year supply of batteries by subscribing to a pre-pay plan. Club membership is $40.00 and entitles you to approximately 10 packages of batteries. When needed, you can order online or give us a call and we will ship the batteries to you for $4.00 per package. Our goal is to continue to provide you with the best service at the best possible prices. Fill our this form and submit to join the Battery Club.

First, Last Name:
Credit Card Billing  Address:
City:
State:
Zip Code:
Home Phone:
Alternate Phone:
Type of Credit Card:(visa mastercard,amex, discover):
Credit Card Number:

Battery
Type:
SIGNATURE:
By typing your name here you are giving the practice permission to charge your credit card to join the battery club and send out batteries.
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