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Orthopedic Surgical Supplies, LLC 510 Route 304 Tel: 845-634-6366 New City, NY 10956 (USA) FAX: 1-845-634-5901 www.ossillc.com E-mail: info@ossillc.com ____________________________________________________________________________________ SHIP TO: Phone:( ) ____________________________________________________________________________________ Address: Fax #:( ) ____________________________________________________________________________________ City: State: Zip: ____________________________________________________________________________________ Country: E-mail: ____________________________________________________________________________________
ITEM | QUANTITY | PRICE | AMOUNT |
PADDED ARTHROSCOPY ANKLE STRAP | $29.95 | ||
CAST THUMB RING - PEDIATRIC * | $29.90 | ||
CAST THUMB RING - SMALL * | $29.90 | ||
CAST THUMB RING - MEDIUM * | $29.90 | ||
CAST THUMB RING - LARGE * | $29.90 | ||
MERCHANDISE TOTAL | |||
NYS CUSTOMERS ADD 8.875% SALES TAX |   | ||
SHIPPING & HANDLING (weight based - we will confirm before shipping) | |||
GRAND TOTAL |
OPTIONAL: Card # ___________________________________________ CVV Code ___________ Expiration Date: _____/_____ Card Holder Signature:______________________________________________________ (Required for credit card authorizations to ship)