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Fill it out and FAX or mail it to Orthopedic Surgical Supplies, LLC 
        
        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

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ORDER:
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      

* Sold in units of 10 rings.       Checks payable to "OSSI, LLC" 

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