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Sorry our Internet order form is Temporarily out of service. Please use Direct mail or copy and send mail order to: myjointidcard @bellsouth.netYou

MAIL ORDERS

Please click MAIL ORDERS link to get a mail order form.
Mail a copy with your check or money order to:
MY JOINT ID CARD
115 Club Court,
Alpharetta, GA. 30005-7424.
Or, Fax to 1-678-762-0158

Internet order form is Temporarily out of service

We request all Internet orders be PRE-PAID by using PAYPAL.

Standard cards are $17.00 (by mail) $18.00 with paypal for the first card and $8.00 for each additional card. (the additional $1.00 for internet covers additional paypal fees)

Custom cards are $40.00 using your x-ray and $18.00 for each additional card

Internet Orders: Please Use the order form below
You can use your TAB key to move through the form.

When completed use the SUBMIT button at the bottom of the page to place your order.
Once submitted you will see a copy of your order. When you go back to the order form it will be cleared of your data, but the order was placed. You do not need to re-place it.
Then please select the Paypal button to pay for your order,

IF YOU HAVE ANY PROBLEMS SENDING ORDER FORM PLEASE CUT, PAST and E-MAIL to: myjointidcard@bellsouth.net

                     Internet/E-Mail ORDER FORM FOR MY JOINT -ID CARD


Order for one Primary card @ $18.00       Order # of Extra Cards @ $8.00 each ?

Total # Cards Ordered?            Total Payment    Georgia residence add 7% state sales tax

Patient Information for Ship to address & How You Want data on the Card

Name of Patient

Street Address

City State Zip Code

Please provide the following contact information in case we have a question on your order

Phone#
Email

Please provide the following Surgical information:
Enter the date of Surgery.. ( mm/dd/yy)
Type Implant: HIP [ Hip replacement ] KNEE [ Knee replacement ] Other
(right or left side; bilateral etc.)
For other Implant or, to add more specific information, please use "additional information" section below.

Name of Doctor
Name of Practice or Hospital
Street Address
City	StateZip Code
Phone#	web site if known

Any additional Information or Special requests

to pay