How to Order


Just fill in all your order details by using the Pull Down Tabs, enter your personal details and click the SUBMIT
button at the bottom of the page. You will receive a Thank You For Filling Out This Form screen. This means
the order has been sent successfully! The order is then manually processed and you'll receive confirmation of the
order within 24 hours.

 

*This order form uses Thawte (Tm) certificate to ensure secure transmission of online transactions.

 

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Prostheses

Item#

Shade

Price

Medical adhesive and solvent

Quantity

Accessories

Quantity

Sub Total: 

Total: 


Name:
(as it appears on card)
Address:
City:
State/Prov:
Country:
Zip/Post Code:
Phone:
Email:
Date of birth:

Method of Payment
Cashier's Check (no personal checks)
Electronic Transfer (email me for details)