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send to :
Precision Orthotic Lab International
MidAtlantic Corporate Center
1595 Imperial Way Suite 103
W. Deptford, NJ 08066 USA
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Name_______________________________________________________ |
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Age ____ Sex ______ Weight _______ Shoe Size*
_____ Type** ______ |
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Address
____________________________________________________ |
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City ______________________ State __________
Zip _______________ |
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Phone number______________________ |
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* USA Sizes **Will fit most shoes, not for
very stylish or special shoes. |
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Product Code
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Price
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$
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$
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Shipping charge***
add $6.95 dls inside USA, $19.95 dls
others countries
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$
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$ |
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Send check or money order payable to Precision
Orthotic Lab International |
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*** Up to 2 orders for same shipping price. |
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Shipping charge inside USA is $6.95 , for other
countries shipping charge is $19.95
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