Compression Socks  

Order by FAX

 		  

Simply print and fill out the form below and fax to 1.818.758.7504

 

Name as on Card

CC# Street Address

CC# City

CC# State

CC# Zip

Shipping Information

First Name: 

Last Name: 

Address: 

City: 

State: 

Zip: 

Phone: 

Email: 

Please print out this order form and mail it to the address on top.
Please include your Check or Money Order.

Calculate Price based on Total Quantity Purchased

3 Pairs Only $10.99 each (Normally $19.99 each) Save 45% = $32.97
4 Pairs Only $ 9.99 each (Normally $19.99 each) Save 50% = $39.96
8 Pairs Only $ 8.99 each (Normally $19.99 each) Save 60% = $71.92

Item Code Color Size Quantity Price Total
CS001 Ivory 7-9      
CS002 Brown 7-9      
CS003 Navy 7-9      
CS004 Black 7-9      
CS005 Ivory 10-13      
CS006 Brown 10-13      
CS007 Navy 10-13      
CS008 Black 10-13      
TOTAL ORDER          

Billing Detail - Credit Card Payments Only

Name as on Card

  

CC# Street Address

  

CC# City

  

CC# State

  

CC# Zip

 

Important Note

We will never automatically ship any more of our products to you or ever bill your credit card again unless you personally reorder.

Shipping

Please select your shipping cost below:

      USA Shipment - $3.95

Credit Card Number _________________________________________

Expiration Date _________________________________________

Signature: _________________________________________

(cardholder signature)