THERA-P-PRODUCTS ORDER FORM

To Order Products - Fax This Form To 416-782-7993
or e-mail us at info@therapyproducts.com
or call on our toll free # 1-800-567-9926

Name
Company
E-Mail Address
Address
City
Province / State
Postal Code / Zip
Country
Home Phone
Business Phone
Fax
Method of Payment	Visa Mastercard
Card Holder Name
Credit Card Number
Expiry Date
MERCHANDISE ORDERED (All prices are in U.S. Dollars)
The New E-V SUNNY "Photo-Optic" SOLAR ELECTRIC BICYCLE	Qty. $ 1795.00
The New E-V SUNNY ELECTRIC ADVANCED POWER ELECTRIC COMMUTER BICYCLE	Qty. $ 1295.0
THERA-P-PRESSURE RELIEF MATTRESS CUSHION	Qty. Size Twin - $ 119.00 Double - $139.00 Queen - $149.00 King - $169.00
THERA-P-SUPPORT CRADLE PILLOW	Qty. Price: $ 46.00
THERA-P-PETITE CRADLE PILLOW	Qty. Price: $ 46.00
THERA-P-ANTI-SNORING CRADLE PILLOW	Qty. Price: $ 59.00 Shipping & Handling Included in Canada and the Continental USA.
THERA-P-BACK CUSHION	Qty. Price: $ 29.95
THERA-P-RELIEF HOT/COLD COMPRESS	Qty. Small - $ 3.50 Medium - $4.50 Large - $10.00
THERA-P-SPORTS WRAP	Qty. Price: $ 10.00
THERA-P-SQUEEZE-ME	Qty. Price: $ 2.95
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THERA-P-CUSHION INC.
46 Dufflaw Road, Toronto, Ontario, Canada M6A 2W1
Tel:905-660-7431 Fax:416-782-7993
Canada & U.S.A. Toll Free:1-800-567-9926