INNERSENSE, INC.

PURCHASE AGREEMENT - ORDER FORM

Date:

Customer:

Address:

Phone:

FAX:

PRODUCT DESCRIPTION
UNITS EA.
PRICE EA.
TOTAL COST
VIBRASOUND® WAVE TABLE
$12,500.00
VIBRASOUND® ZERO GRAVITY CHAIR
3995.00
VIBRASOUND® MASSAGE TABLE
2995.00
SENSORIUM™ LSV SENSORY INTERFACE
695.00
ABSOLUTE SCALE OF RELATIVE COSMIC REALITY™
300.00
HARMONIC LAW™: THE SCIENCE OF VIBRATION (CD ONLY)  
75.00
 
GREAT DIESIS™ HARMONIC REINFORCEMENT CDs:
SEE BELOW
PURE WHITE SOUND (68 MINUTES)
33.00
PURE PINK SOUND (68 MINUTES)
33.00
PURE BREATH (68 MINUTES)
33.00
PURE RAIN (68 MINUTES)
33.00
PURE SLEEP (68 MINUTES)  
33.00
PURE ASCENSION (68 MINUTES)
33.00
PURE DESCENSION (68 MINUTES)  
33.00
 
HARMONIC REINFORCEMENT SET (ALL SEVEN CDS)
200.00
GDCD SAMPLER (10 MIN EACH ALL SEVEN SOUNDS)
33.00
TRANSFORMANT™ ALLASSO CONCENRATE (50 ml.)
65.00
OTHER:
OTHER:
CALIFORNIA SALES TAX (8.25%)
SHIPPING AND HANDLING (CALL FOR PRICE)
TOTAL SALE
DEPOSIT
BALANCE DUE

 

Card Number, Expiration Date and 3 Digit Code on Back of Card in Sign Line

 

Name as shown on card:

 

Address Associated with card account (if different than above):

 

Customer here by authorizes InnerSense, Inc. to charge the "Total Sale" amount as indicated on this form. InnerSense, Inc. accepts no

returns on these items.  Credit is limited to repair or replacement of damaged merchandise only.  Call for return authorizations for

damaged goods.  All products are warranted for a period of one year from purchase. 

 

Accepted by (customer signature):       _________________________________Date:    ______________

 

Customer:  Please fill in, sign, and fax this form to (310) 829-9784 or mail to 2118 Wilshire Blvd. #730, Santa Monica, CA. 90043.