Beat my Doctors Prices!

THIS FORM ONLY TAKES 5 MINUTES TO FILL OUT SAVING YOU LOTS OF MONEY. GUARANTEED! WHY NOT SAVE? THERE ARE NO GIMMICKS. YOUR NAME WILL NOT BE ADDED TO ANYONES MAILING LIST.

INSTRUCTIONS: PRINT THIS FORM! (USE THIS FORM TO KNOW WHAT TO ASK.)

 AFTER HAVING YOUR "FREE HEARING TEST", GET AS MUCH INFORMATION AS POSSIBLE ABOUT THE TYPE OF HEARING AID(S) YOU WANT. DON'T FORGET TO  ASK FOR A COPY OF YOUR TEST AND RETURN TO THIS PAGE.  FILL OUT THIS FORM AS ACCURATELY AS POSSIBLE AND CLICK  THE SEND BUTTON.

 WE WILL REPLY WITHIN 24 HOURS WITH A GUARANTEED LOWER PRICE!  

TO EXPEDITE, PLEASE FAX A COPY OF THE HEARING TEST TO OUR OFFICE. (207)877-9981

THANK YOU.

CUSTOMER INFORMATION: TAB TO NEXT FIELD.

*NAME: *(REQUIRED)

*E-MAIL ADDRESS: * (REQUIRED)

HOW DID YOU FIND US?(OPTIONAL)

HEARING AID(S) QUOTE:

ENTER YOUR  INFORMATION:

MANUFACTURER *(REQUIRED) EXAMPLE: BELTONE

STYLE OF AID * (REQUIRED) EXAMPLE: FULL, CANAL, MINI CANAL

TYPE OF CIRCUIT * (REQUIRED) EXAMPLE: DIGITAL 2 CHANNEL

RIGHT OR LEFT OR BOTH * (REQUIRED) EXAMPLE: BOTH

PRICE OF AID(S) EXAMPLE: $2155.00 (WOW!)

E-MAIL ME NOW

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