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Aculife i-doc / D-178 Purchase Request Form 購買申請表
Please complete the following and you will receive an email with the invoice for your purchase.
請完成以下訊息，您將會收到一封含有購買發票的電子郵件。
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* Indicates required question
Email
*
Your email
Full Name
姓名
*
Your answer
Member ID or Username
會員ID或用戶名
*
Your answer
Note: Existing Member who wants to activate their second or third account, please specify your unit code.
備註：現有會員若欲啟動第二或第三個帳戶，請註明單位代碼。
Your answer
Number of
i-Doc Electro Acupuncture Device
you wish to purchase
i-Doc 活磁波雙向手診儀
購買數量
Your answer
Number of
Aculife Electric Potential Therapy Device (D-178)
you wish to purchase
負電位治療機 (D-178)
購買數量
Your answer
Shipping Country
發貨國家
*
Your answer
Shipping Address
發貨地址
*
Your answer
City
城市
*
Your answer
State / Province
州/省
*
Your answer
Postal Code
郵編
*
Your answer
Contact Number
聯絡號碼
*
Your answer
Payment Mode
支付方式
*
Credit / Debit Card 信用卡/簽帳金融卡
Bank Wire Transfer 銀行電匯
USDT (TRC20)
A copy of your responses will be emailed to the address you provided.
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