Coopercare

On-line order form

Order Online,

or fax toll free 888-562-2095

or call toll free 866-503-5523

 

Please provide the following ordering information:

Lastrap Product Size Price $ U.S. inc. tax Quantity
Lastrap-Elbow   $20.00  
  XS (8 1/2" - 9 1/2")  

  S (9 1/2" - 10 1/2")  
  M (10 1/2" - 11 1/2")  
  L (11 1/2 - 13")  
Lastrap-Shoulder   $25.00  
  One size fits all  
Lastrap-Leg   $20.00  
  S (9 1/2" - 11 1/2")  
  M (11 3/4" - 15")  
  L (15 1/4" - 20")  
Lastrap-Back   $25.00  
  S (up to 30")  
  M (30" - 36")  
  L (36" - 44")  
  XL (44" - 52")  
Lastrap-Wrist   $20.00  
  Right - S (6 1/2"- 7 1/2")  
  Right M (7 1/2 - 8 1/2")  
  Right L(8 1/2 - 9 1/2")  
  Left- S (6 1/2"- 7 1/2")  
  Left M (7 1/2 - 8 1/2")  
  Left L(8 1/2 - 9 1/2")  
Lastrap-Knee   $20.00  
  S (12" - 15 1/2")  
  M (15.5"- 19")  
  L (19" - 22")  
  XL (22" - 242")  
BILLING
Credit card
Cardholder name
Card number
Expiration date
SHIPPING
E-mail
Telephone #
Name
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country

Shipping (USA & Canada): $5.00

Shipping (International): $10.00

Money back guarantee:    Return within 10 days

Please do not hesitate to call us.  This order form may also be printed and faxed or mailed to:

 

Coopercare-Lastrap
329 Deerhide Crescent, Toronto, Ontario, Canada M9M 2Z2
Tel: 416 741-9675 Fax: 416 741-2873

Home

Send mail to painrelief@coopercare.ca with questions or comments about this web site.
Copyright © 1998 CompanyLongName