SLIPPĀ® ORDER FORM



UNIT NUMBER_____________                                                     DATE:______________

QTY ORDERED______ SIZE_______ @$________  AMOUNT DUE $___________

                                                                                                                        SHIPPING $_________

P.O. #____________                                                                                                                          

FACILITY NAME__________________________________________________

SHIPPING ADDRESS_______________________________________________

CITY,STATE,ZIP__________________________________________________ 

CONTACT PERSON________________________________________________

DEPT._____________________  PHONE______________________________

EMAIL_________________________________________________________

How did you find out about SlippĀ®?____________________________                        

Department being purchased for________________________________                    

BILL TO ADDRESS________________________                                                                 

                                                       ________________________                                                                                    




FOR YOUR ORDERING CONVENIENCE THIS FORM MAY BE:

MAILED TO: Wright Products Inc, 1909 S. Taylorville Road, Decatur, IL 62521

PHONED TO: 1-800-356-6911

FAXED TO: 1-217-423-7282

EMAIL: slipp@wrightproductsinc.com

www.wrightproductsinc.com


PRODUCT INFORMATION

Slipp® Patient Mover
72" X 28" Full Size   Product code # 75477
56" X 33" 3/4 Size   Product code # 75477.1

Bariaric Slipp®
76" X 45" Bariatric   Product code # Bari
Volume discounts available on 10 units or more.
All units come with a carrying case, 4 minute DVD instructions, written instructions, and a one year warranty against defects in materials and workmanship.
TERM Net 30 Days
Call 1-800-356-6911 for questions or addtional information.