@ IEM Orthopaedic Systems - Medical Supplier of Sorbothane and Orthopaedic supports for insoles, lumbar, maternity

Orthopaedic Systems

Miscellaneous

Fax/Mail Order Form

We only accept

MC & Visa for all Manual Transactions!

7108 State Route 14
P.O. Box 592
Ravenna, Ohio 44266

United States
(800) 992-6594

Canada
(800) 243-6594

Fax
(330) 297-6568

Proud Distributor of Sorbothane Products and More!

Fax or Mail us your order!

Description	Male	Female	Shoesize	Price	Qty	Extended
VISCO-ELASTIC				18.95/PR
VISCO-ELASTIC HEEL				10.95/PR
ACCOMODATIVE HEEL PAD				13.95/PR
HEEL CUP				7.95/PR
ULTRA-SOLE INSOLE				18.95/PR
ULTRA-SOLE INSOLE WITH GRAPHITE ARCH				29.95/PR
SORBO-AIR INSOLE				18.95/PR
3/4 LENGTH INSOLE WITH GRAPHITE ARCH				29.95/PR
3/4 LENGTH INSOLE W/O GRAPHITE ARCH				16.50/PR
EXER-BALL				5.95
HANDEX CONE				5.95
HANDEX BLOCK				5.95
Subtotal				$		$
Ohio residents add 6.25% state sales tax				$		$
Continental USA Shipments Shipping charge first item 4.00				4.00
Shipping each additional item.. .50				.50
Canadian Orders: Canadian Air Parcel Post 10% of Total Priceof Items Ordered ($10.00 minimum charge)
TOTAL US FUNDS						$
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MAKE CHECKS PAYABLE TO: IEM Medical Technologies, Inc. MAIL TO: IEM Medical Technologies, Inc. P.O. Box 592 Ravenna, Ohio 44266-0592 Or Fax to 330-297-6568