Your Address
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Your Name
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Street
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City
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State and Zip
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Your daytime phone
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PLEASE CHECK: ( )Check enclosed ( )Discover ( )Mastercard ( )VISA
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QUANTITY/SIZE
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DESCRIPTION
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PRICE
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AMOUNT
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HEAD, ARM, & SHOULDER
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Elbow Support - One size fits all
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24.50
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Tennis Elbow (Universal Elbow) - One size fits all
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15.95
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Eye Mask - One size fits all
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24.95
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Facemask - One size fits all
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74.95
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Head Band - One size fits all
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24.95
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Neck Collar 30" x 3.5" - One size fits all
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33.95
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Universal Wrist - One size fits all
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13.95
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Magnetic Hand Mitt - One size fits all
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27.95
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Thumb & Wrist Support - One size fits all
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22.95
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Universal Kit - One size fits all
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35.50
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BACK & LEGS
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Ankle Support - One size fits all
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20.95
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Knee Stablizer - Trioxon - Indicate ( )Up to 14.5" or ( )Up to 16.75"
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62.95
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Lumbar Back Support - Deluxe - S/M 24" to 30"
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59.95
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Lumbar Back Support - Trioxon - L/XL 31" to 40"
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97.95
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Shin Support - One size fits all - 7.25"b x 4"
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29.50
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Thigh Support - One size fits all - 26" x 6"
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38.95
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Car Seat/Universal Therapy Pad - One size
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96.95
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INSOLES
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Flat Insoles - Men - Indicate ( )9 ( )10 ( )11 ( )12
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23.50
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Flat Insoles - Women - Indicate ( )6 ( )7 ( )8 ( )9 ( )10
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23.50
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Magnetic Orthotics - Men - Indicate ( )9 ( )10 ( )11 ( )12
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57.95
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Magnetic Orthotics - Women - Indicate ( )6 ( )7 ( )8 ( )9 ( )10
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57.95
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INDIVIDUAL MAGNETS
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Card Magnet - 2 Pack - 2" x 3.25"
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19.50
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Max-Circle Magnetic Pad - Each - 3.5" diameter
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19.50
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Mini Magnetic Circle - 2 Pack - 1.5" diameter
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19.50
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Flex Lumbar Magnetic - 5.5" x 6.29" x 8.29"
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59.50
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Magnetic Strip 2" x 7"
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27.00
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Card Adhesive - 30 Pack
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8.95
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Max Circle Adhesive - 30 Pack
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12.00
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Mini Circle Adhesive - 30 Pack - small
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4.50
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MATTRESS OVERLAY
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Personal Mattress Overlay - 24" x 75"
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240.95
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Twin Mattress Overlay - Twin 30" x 72"
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290.95
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Full Mattress Overlay - Ful 52" x 72"
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428.95
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Queen Mattress Overlay - Queen 72" x 72"
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469.95
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King Mattress Overlay - King 74" x 78"
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589.95
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PET ACCESSORIES
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Magnetic Nylon Dog Collar - Indicate ( )S or ( )M or ( )L or ( )XL
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45.00
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Pet Pads - Indicate ( )Medium $59.95 or ( )Large
$79.95
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TRIOXON PRODUCTS
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Trioxon Knee Support - Indicate ( )S/M or ( )L/XL
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62.95
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Tiroxon Knee Support - XXL with straps
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64.95
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Trioxon Universal (Tennis) Elbow
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25.95
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Trioxon Elbow Support - Indicate ( )S/M or ( )L/XL
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34.95
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Trioxon Wrist Splint - Indicate ( )S/M or ( )L/XL and ( )Right or ( )Left
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37.95
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Trioxon Universal Wrist - Indicate ( )S/M or ( )L/XL
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24.95
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Trioxon Lumbar Suport - ( )S/M:24 to 30" or ( )L/XL:31 to 40"
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97.95
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Trioxon Ankle Support - One size fits all
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37.95
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Blank
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Merchandise Total
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S/H Charge
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$0 - $25.00
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$7.00
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$25.01 - $60.00
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$8.00
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$60.01 - $120.00
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$9.00
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$120.01 - $200.00
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$11.00
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$200.01 - $400.00
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$12.00
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$400.01 - $500.00
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$15.00
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$500.01 - $750.00
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$16.00
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$750.01 - $850.00
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$18.50
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