MOBILIZRô Torso Support System Order Form

  One Size fits all Adult MOBILIZRô                                                                 $189.00/ea. 

  One Size fits all Toddler/Petite MOBILIZRô                                                    $179.00/ea  

  NEW One size fits all Shower model.                                                                 $129.00/ea  

  Extra Attachment Kits.                                                                                         $29.00/set 

  Quick Attachment Kit.                                                                                         $39.00/ea  

  Extra Comfort Pad                                                                                                  $8.95/ea 

  Free Shipping & Handling                                                                                                      

  Idaho residents add 6% sales tax.  Government Exempt.                                                        

  (Please allow 2 to 4 weeks for shipping)                                                                   Total =  

 Ship To:     First name

Last name

Street address

City

State/Province

Zip Code

Country

Phone

E-mail

Type of Disability

Mobility Device:
Make:

Model:

Please SelectVISA        MASTER CARD  

        Name on card:
                 Card #:

        Expire date :
   Security Code :

Please print this form and mail or fax with payment information to:

Williams Enterprises LLC - 4723 Airport Road - Nampa, Idaho 83687   
                              Call for questions (208) 466-1290