Get Westone Order Form

Filling out the Westone Order Form is essential for ensuring that your custom earpiece order is processed efficiently. This guide offers clear, step-by-step instructions to help you complete the form accurately.

Follow the steps to successfully complete your order form.

1. Click the ‘Get Form’ button to obtain the form and open it in your browser.
2. Begin by entering your patient’s name and age, followed by the date on the designated lines.
3. Fill in the dispenser information section completely. This includes the dispenser’s name, company, address, and phone number, ensuring all details are accurate.
4. Choose the shipping code relevant to your location, selecting between Colorado Springs or Kalamazoo.
5. Indicate where the order should be shipped by selecting either the dispenser’s address, patient’s address, or another specified address. If you select 'Other Address', fill in the additional details as needed.
6. Select your desired shipping method from the options provided, keeping in mind any additional charges that may apply.
7. In the billing method section, choose how you will pay for the order, whether through a Westone account, credit card, or check/money order.
8. Provide the credit card information if applicable, including the billing address and card details, ensuring accuracy to avoid delays.
9. Enter specific earpiece information, including the style for both the left and right earpiece as needed.
10. Make any special requests or provide additional information relevant to the order in the designated section.
11. Fill out the hearing loss section, which includes selecting from mild to profound levels and completing an audiogram if necessary.
12. Choose the venting and tubing options that apply for the earpiece and fill in any corresponding sizes.
13. Indicate the earpiece finish and any additional options you wish to include.
14. Once all fields are completed and verified for accuracy, save your changes, download, print, or share the form as needed.

Complete your Westone Order Form online today to ensure a smooth ordering process.