Use this form if you want to pay by check or issue a PO.  We will email you a Proforma Invoice with a total amount as well as instructions on how to make payment.  Be sure to select the payment method you prefer.  This quote will take up to 24 hours to arrive, if you are in a hurry we suggest using credit/debit card and purchasing from here.  Note that we only accept checks in US dollars and we do not accept personal checks.  

Name *
Name
Shipping Address *
Shipping Address
Billing Information
Only necessary if different from shipping.
Billing Name
Billing Name
Billing Address
Billing Address
Payment Method *
Product (Use Special Instructions below if ordering multiple) *
Tell us anything we need to know, such as if you want expedited shipping or multiple products.
IMPORTANT! READ THIS FIRST! SAMi is a nocturnal movement monitor and will detect all types of movement regardless of the movement’s origin. HiPass Design LLC does not guarantee the effectiveness of SAMi for any particular application and use of SAMi is solely at your own risk. SAMi has not been evaluated or approved by the U.S. Food and Drug Administration or any other government agency for any purpose. SAMi is not a medical device and is not intended for use in the prevention, diagnosis, mitigation, treatment, or cure of any disease or other conditions. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. *
Please check box to indicate your acceptance of these terms of sale.
How did you hear about us? (optional)