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Accu-Chek Pre-Booking Form For Representatives- V3

Fill in the fields below to order and identify the pharmacy.

Product Ordering
Product NameRegular Cost*Promotion Cost*Quantity
2 unit displayer
$70.00
$35.00
Accu-Chek Guide Meter
$35.00
$17.50
Accu-Chek Aviva Meter
$25.00
$12.50
Accu-Chek Guide Strips 100
$68.13
N/A
Accu-Chek Guide Strips 50
$34.07
N/A
Accu-Chek Aviva Strips 100
$71.25
N/A
Accu-Chek Aviva Strips 50
$40.70
N/A
Softclix Lancets 100
$7.70
N/A
Softclix Lancets 200
$14.50
N/A