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Zyto Scan Authorization

I agree that MyPure Health Solutions is going to send me a hand cradle for my program's remote Zyto scan.

I understand the cost of the hand cradle is $250 USD and I will be responsible for this amount if the cradle is not returned in working function within three business days after scanning.

Return to 1346 W Columbia Ave, Battle Creek, MI 49015

A card must be on file in order to participate in the Zyto Scan. Your card will not be charged unless the Zyto hand cradle was damaged or lost.

Credit Card Information

Cardholder Name

*

Card Number

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Expiration Date

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CVV

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Zipcode

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Full Name

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Email

*

Authorization

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Signature

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