PHYSICIAN ORDER FORM
Bill To Address
Ship To Address
Physician Name
Physician Name
Street Address
Street Address
Suite
Suite
City
City
State
State
Zip
Zip
G
C
D
E
F
H
A
B
QTY.
DISCOUNTS
1-     35 Prs.          0%
36-  143 Prs.        10%
144-287 Prs.        15%
288+      Prs..        20%

CREDIT CARDS     
5%
              
Redi-Thotics FLEX
Redi-Thotics SLIM
Redi-Thotics CONTROL
Redi-Thotics MAX
Redi-Thotics ULTRA
Redi-Thotics QUIK-FORM
BALANCE 3/4        
BALANCE FULL LENGTH       
Redi-Thotics FREEDOM
Redi-Thotics COMFORT
F
B
C
A
D
E
H
G
QTY.
EXECUTIVE 3/4
EXECUTIVE SULCUS
EXECUTIVE FULL
XS
S
M
L
XL
TOTAL
Redi-Thotics  AWESOME
Redi-Thotics  CHAMP
Redi-Thotics  PEDIAFORM
Redi-Thotics  PEDIAFORM
Orders in boxes of 12 packs
Redi-Helperz  Met Pads Sm.
Redi-Helperz  Met Pads Lg..
Degrees
Boxes
Redi-Helperz Posts
3, 4, 5
degrees
                                                          ADULT SIZING CHART

                   A           B            C                 D                  E                 F                G                  H
Mens            5-6.5     7-7.5        8-8.5          9-9.5          10-10.5        11-13        13.5-15        15.5-17
Womens       6-7.5     8-8.5        9-9.5        10-10.5        11-11.5        12-14        
European     35/36    37/38       39/40          41/42           43/44         45/47          48/49           50/51      
                 KIDS SIZING CHART

            XS          S         M        L        XL
            8-9      10-11  12-13    1-2      3-4
To update your credit card information please call our main office:
   
          860-417-3589