| TABLE REPLACEMENT COVER ORDER FORM |
| SEND TO: KEVIN HILL, 111 LAWTON BLVD., SUITE 708, TORONTO, ONTARIO M4V 1Z9 |
| Phone 416.487.0258 |
Please right click your
mouse- print and fill out form- forward with payment to the above address.
Seven business days required to process order upon receipt of payment and form.
Color
Chart
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| For tables in group A and B |
| Circle the name of your table: Mercury Electra Elite Diplomat Dynasty Raymax Elegenza Signature Series Continental Hermoff Man. Triumph TC503 Circle: Stationary or Electric |
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NO C.O.D. ORDERS, NO RETURNS OR REFUNDS ONCE MATERIAL IS CUT. |
| QTY: | Products: | Colour Number |
Cover Price |
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| #1 HANDREST COVER | $39.00 | ||||||||
| (Specify Type) | |||||||||
| #2 HEADREST COVERS (PR.) | $65.00 | ||||||||
| #3 THORACIC COVER | $65.00 | ||||||||
| #4 PELVIC COVER | $65.00 | ||||||||
| #5 LEG COVER | $48.00 | ||||||||
| #6 FOOT EXTENSION COVER | $38.00 | ||||||||
| COMPLETE SET OF COVERS | $239.75 | ||||||||
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| QTY: | Tables in group C- Activators | ||||||||
| Esprit, L3000, Lesarn, Softec | |||||||||
| COMPLETE SET OF COVERS | $239.75 | ||||||||
| Circle table width 24" 26" 28" | |||||||||
| Date: | __________________ |
Signature:_________________________ Sub Total: |
$___________ |
| Please make check payable to: Return form with payment to: Kevin Hill 111 Lawton Blvd., Suite 708 Toronto, Ontario M4V 1Z9 |
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Shipping and Handling 1-3 Covers $14.75 4-5 Covers $18.75 Complete Set $21.75