Order form about a chest exercise device

please fill out online

Stefan K�hnst
produce of breathing devices
Techno CED
Dorfstra�e 53
D-06217 Merseburg - Meuschau Germany
Tel./Fax: +49(0)3461217024

E-Mail: stefankuehnst@hotmail.com
Child's Name:

Date of Birth:

Gender: Female: Male:

Date of your next visit in the institut It is very important to give this date!





Information to parents
Mother's name Father's name


postal code


a) Vest: Each vest will be fitted to the measurements of your child. Please provide exact measurements. Write down the measurements on the included page. The vest is adjustable by one size, thereby guaranteeing, that it will fit your child longer.

b) control box: The control box works between 80 and 240 volt. The controlbox does regulation the voltage self, which you need for your country. The device with serial-number 7002038 Type AH3 is CE-conform.

c) Compressor: The compressor works very quiet and is very small (weight; 4, 8 kg, size 0, 20 x 0, 15 x 0,15). The compressor works very good with the vest and control box together it is very comfortable for the children's to sleeping in the night.

Items to be delivered
please fill out
voltage: 220 Volt 50 Herz: 110 Volt 60 Herz
Number of pieces.:

Summe: 2800,- € + cost for wrapping and shipping

The cost for shipping, you get it after you have sent me the order form back.

adjustable breathing vest
control box 1,
control box 2,
air hoses,
valves and bladders

Terms of payment:

- The full amount due must be paid before delivery. Please take into consideration that the machine must be paid for in advance.

- Please notice, the produce of your device beginning after arrival your money-transfer. The delivery time will be 3 - 4 weeks!!!

- Please make the money-transfer only in Euro. You get all information about this by your bank-office. Please include the
name of your   child with the remittance. It is very important!!

- As soon arrival your money-transfer, you get a confirmation about this and the exactly delivery date.

Please notice:
I want to inform you, that the copying in any shape or form of the inflatable breathing vest device is not allowed.

About the measurements for the breathing vest:
- Please make the measurements follwing:
- use a measuring tape. Put it circumference of the body of your child
- Please write the numbers into the units of measurements. Don't subtract something!!!
- Your child have to carry wear during the measurements.
- If your child needs pampers, please make the measurements with pampers!!

Beneath Armpits.:




Measure width of chest from armpit to armpit.:

Measure from armpit to waist.:

Measure from waist to hip.:

Measure from beneath armpits to where the legs bends.: