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.