MOBILIZR™
Torso Support System Order Form
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1 Size fits all Adult MOBILIZR™ Torso Support System $189.00/ea. |
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1 Size fits all Toddler MOBILIZR™ Torso Support System $179.00/ea. |
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| NEW Shower model. Safety in the shower $89.00/ea. | |
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Extra Attachment Kits. $29.00/set |
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Extra Comfort Pad $8.95/ea. |
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Free Shipping & Handling |
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Idaho residents add 6% sales tax |
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(Please allow 2 to 4 weeks for shipping) Total = |
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First name |
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Last name |
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Street address |
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City |
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Age |
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State/Province |
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Weight |
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Zip Code |
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Height |
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Country |
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Phone |
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Type of Disability |
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Mobility
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Make: |
Model: |
Please print this form and mail with payment to:
Williams
Enterprises LLC - 4723 Airport
Road - Nampa, Idaho 83687
(208) 466-1290
Toll Free: (888) 880-0073