THERA-P-PRODUCTS ORDER FORM

To Order Products - Fax This Form To 905-660-2427
or e-mail us at info@therapyproducts.com
or call on our toll free # 1-800-567-9926

Name: E-Mail Address: Street Address: Phone: Fax: Method of Payment: Visa Mastercard Credit Card Number: Expiry Date: Card Holder Name: MERCHANDISE ORDERED (All prices are in U.S. Dollars)   E-V SUNNY SOLAR/ELECTRIC (PEDAL ASSIST) BICYCLE Qty. Pre-Assembled $ 1295.00 Kits are available starting at $795.00     THERA-P-PRESSURE RELIEF MATTRESS CUSHION Qty. Size Twin - $ 119.00 Double - $139.00 Queen - $149.00 King - $169.00   THERA-P-SUPPORT CRADLE PILLOW Qty. Price: $ 36.00   THERA-P-PETITE CRADLE PILLOW Qty. Price: $ 36.00   THERA-P-ANTI-SNORING CRADLE PILLOW Qty. Price: $ 59.00 U.S. Funds Shipping & Handling Included in Canada and the Continental United States of America. THERA-P-BACK CUSHION Qty. Price: $ 29.95 THERA-P-RELIEF HOT/COLD COMPRESS Qty. Small - $ 3.50 Medium - $4.50 Large - $10.00 THERA-P-SPORTS WRAP Qty. Price: $ 10.00 THERA-P-SQUEEZE-ME Qty. Price: $ 2.95   Please add any comments or special instructions below:

THERA-P-CUSHION INC.
46 Dufflaw Road, Toronto, Ontario, Canada M6A 2W1
Tel:905-660-7431 Fax:416-782-7993
Canada & U.S.A. Toll Free:1-800-567-9926