Fill out form online and print
or
print blank form and write in order information.
Then fax to:
303-238-3186
or call
303-238-3185
with order information.
Qty
Description
Color
Size
Price
Subtotal
Shoulder Warming Wrap...............................
Lumbar Belt
Back Warmer
Knee Wrap
Warming Mitts
Warming Slippers (specify size)
Neck/Wrist Roll
Eye Mask
All Purpose Warming Bag
Buddy Mate for Kids
Navy Blue
Burgundy
Green
Medium
Large
Shoulder Warming Wrap...............................
Lumbar Belt
Back Warmer
Knee Wrap
Warming Mitts
Warming Slippers (specify size)
Neck/Wrist Roll
Eye Mask
All Purpose Warming Bag
Buddy Mate for Kids
Navy Blue
Burgundy
Green
Medium
Large
Shoulder Warming Wrap...............................
Lumbar Belt
Back Warmer
Knee Wrap
Warming Mitts
Warming Slippers (specify size)
Neck/Wrist Roll
Eye Mask
All Purpose Warming Bag
Buddy Mate for Kids
Navy Blue
Burgundy
Green
Medium
Large
Shoulder Warming Wrap...............................
Lumbar Belt
Back Warmer
Knee Wrap
Warming Mitts
Warming Slippers (specify size)
Neck/Wrist Roll
Eye Mask
All Purpose Warming Bag
Buddy Mate for Kids
Navy Blue
Burgundy
Green
Medium
Large
Shoulder Warming Wrap...............................
Lumbar Belt
Back Warmer
Knee Wrap
Warming Mitts
Warming Slippers (specify size)
Neck/Wrist Roll
Eye Mask
All Purpose Warming Bag
Buddy Mate for Kids
Navy Blue
Burgundy
Green
Medium
Large
Shoulder Warming Wrap...............................
Lumbar Belt
Back Warmer
Knee Wrap
Warming Mitts
Warming Slippers (specify size)
Neck/Wrist Roll
Eye Mask
All Purpose Warming Bag
Buddy Mate for Kids
Navy Blue
Burgundy
Green
Medium
Large
Shoulder Warming Wrap...............................
Lumbar Belt
Back Warmer
Knee Wrap
Warming Mitts
Warming Slippers (specify size)
Neck/Wrist Roll
Eye Mask
All Purpose Warming Bag
Buddy Mate for Kids
Navy Blue
Burgundy
Green
Medium
Large
Name:
Order Total:
Address:
7.6
% tax
(CO residents Only)
:
City:
, State:
Zip
Shipping
(see table below)
:
Phone #:(
)
-
Total:
E-mail:
Payment Method:
Check
Cash
Visa
MasterCard
Shipping
(All Standard Rates. Base shipping on item cost before taxes)
$0 - $20.00
$4.95
$20.01 - $40.00
$5.95
$40.01 - $60.00
$7.95
$60.01 - $80.00
$8.95
$80.01 - $$100.00
$9.95
$100.01 - $120.00
$10.95
Credit Card #
Exp. Date
Over $120.00
12% of Total
Signature
CSC
Free delivery within delivery boundaries. Call for delivery areas.