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Print and Mail to:
Crutch Tote™,
100 E. Bellevue Pl. Suite 4E, Chicago, IL 60611 |
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ORDERED BY |
SHIP TO (If Different) |
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Zip: |
Zip: |
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Shipping Address is a __ Residence __Business |
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QTY |
Description |
UNIT PRICE |
TOTAL |
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Crutch Tote™ Crutch Bag(s) |
17.95 |
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Sub Total |
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Shipping |
$6.95 |
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IL State Tax |
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Amt. Due |
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Please be sure to enclose check or money order, payable to Crutch Tote™ |
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TERMS: Net cash with order. Orders will be shipped upon receipt of payment. |