WORD-order-form

Order Form Specific Merge Fields Invoice date Order date Order deposit HA sale payment(s) total HA order Insurer coverage (total) Patient payable on order HA sale balance due Order total Order subtotal (total – taxes) Order total w/o discount/tax Tax total Other services, batteries, accessories sold Discount total HA sale Invoice number HA dispenser on order Order ship to location Order bill to location Left HA manufacturer Left HA manufacturer address Left HA model Left HA style Left HA serial number Left HA price Left HA purchase date Left HA discount amount Left HA subtotal Left delivery date ‘L’ for left side Left HA battery size Left HA Warranty exp. date Left HA L&D Warranty exp. date Left HA color Left HA notes Left HA service plan name Left HA service plan expiration date Left HA option(s) Left HA option(s) price Right HA manufacturer Right HA manufacturer address Right HA model Right HA style Right HA serial number Right HA price Right HA purchase date Right HA discount amount Right HA subtotal Right HA delivery date ‘R’ for right side Right HA battery size Right HA Warranty Exp. date Right HA L&D Warranty exp. date Right HA color Right HA notes Right HA service plan name Right HA service plan expiration date Right HA option(s) Right HA options(s) price Other HA manufacturer Other HA manufacturer address Other HA model Other HA style Other HA serial number Other HA price Other HA purchase date Other HA discount amount Other HA subtotal Other HA delivery date ‘O’ for other side Other HA battery size Other HA Warranty Exp. date Other HA L&D Warranty exp. date Other HA color Other HA notes Other HA service plan name Other HA service plan expiration date Other HA option(s) Other HA price Aid warranty length Left Orderable item Manufacturer Left Orderable item Manufacturer address Left Orderable Item model Left Orderable Item style Left orderable Item serial number Left orderable item price Left Orderable item purchase date Left orderable item discount amount Left orderable item subtotal Left orderable item delivery date “L” for left orderable item side Left orderable item battery size Left orderable item Warranty exp. Date Left orderable item L&D Warranty exp. Date Left orderable item color Left orderable item Notes Left orderable item service plan name Left orderable item service plan expiration date Right Orderable item Manufacturer Right Orderable item Manufacturer address Right Orderable Item model Right Orderable Item style Right orderable Item serial number Right orderable item price Right Orderable item purchase date Right orderable item discount amount Right orderable item subtotal Right orderable item delivery date “R” for right orderable item side Right orderable item battery size Right orderable item Warranty exp. Date Right orderable item L&D Warranty exp. Date Right orderable item color Right orderable item Notes Right orderable item service plan name Right orderable item service plan expiration date Other Orderable item Manufacturer Other Orderable item Manufacturer address Other Orderable Item model Other Orderable Item style Other orderable Item serial number Other orderable item price Other Orderable item purchase date Other orderable item discount amount Other orderable item subtotal Other orderable item delivery date “O” for left orderable item side Other orderable item battery size Other orderable item Warranty exp. Date Other orderable item L&D Warranty exp. Date Other orderable item color Other orderable item Notes Other orderable item service plan name Other orderable item service plan expiration date Signed by first name Signed by last name Signed by qualifications Signed by job title