A Division of Wrymark, Inc.
11833 Westline Industrial Drive
St. Louis, MO 63146-3312
Orders:
St. Louis:
Fax:
Date:
Time:
Customer #:
Order #:
P.O. #:
(800) 969-3668
(314) 991-3891
(314) 991-5720
BILL TO:
SHIP TO:
CONTACT PERSON:
TELEPHONE:
SHIPPING:
‫ ٱ‬GROUND ‫ ٱ‬NEXT DAY ‫ ٱ‬2nd DAY ‫ ٱ‬3rd DAY DATE REQUIRED
TOTAL ORDER INFORMATION
PRODUCT
QUANTITY
TOTAL AMOUNT
1st Step Insoles
1st Step Heel Pads
Other
TOTAL
PRE-MOLDED INSOLES WITH ARCH SUPPORT AND HEEL CUSHION
*Volume discounts are available as follows: 1-12 pair = $22/pair, 13-25 pair = $21/pair, 26+ pair = $20/pair
WOMEN’S SHOE SIZES
Full Length 1/8” Poron
®
3-4
7-8
9-10
11-12
QTY
FFLM
3/4 (Sulcus) Length 1/16” Poron®
FFDM
Full Length Accommodative 1/8” Poron® 1/8” Plastazote®
FFPM
Full Length Forefoot Split 1/8” Poron®
FFSM
3/4 (Sulcus) Length Forefoot Split 3/32” Poron
®
6-7
®
8-9
MFDM
Full Length Accommodative 1/8” Poron® 1/8” Plastazote®
MFPM
Full Length Forefoot Split 1/8” Poron®
MFSM
3/4 (Sulcus) Length Forefoot Split 3/32” Poron
®
TOTAL
10-11 12-13 14-15
MFLM
3/4 (Sulcus) Length 1/16” Poron®
PRICE
22.00
22.00
22.00
22.00
22.00
FFDSM
MEN’S SHOE SIZES
Full Length 1/8” Poron
5-6
22.00
22.00
22.00
22.00
22.00
MFDSM
TRI-LAMINAR THERMOLDABLE INSOLES
*Volume discounts are available as follows: 1-12 pair = $9/pair, pair = $8/pair, 26+ pair = $7/pair
WOMEN’S SHOE SIZES
®
5-7
ThermoCork - Cork, Poron , EVA topcover
FFCM
H-Cell - EVA, Moldable H-Cell, EVA topcover
FFHM
Diabetic - EVA, Poron®, EVA topcover
FFDBM
MEN’S SHOE SIZES
®
MFCM
H-Cell - EVA, Moldable H-Cell, EVA topcover
MFHM
Diabetic - EVA, Poron®, EVA topcover
MFDBM
10-11 12-13
QTY
PRICE
TOTAL
9.00
9.00
9.00
6-7
ThermoCork - Cork, Poron , EVA topcover
8-9
8-9
10-11 12-13 14-15
9.00
9.00
9.00
Revised 10/01/02
A Division of Wrymark, Inc.
11833 Westline Industrial Drive
St. Louis, MO 63146-3312
Orders:
St. Louis:
Fax:
(800) 969-3668
(314) 991-3891
(314) 991-5720
STANDARD FLAT INSOLES
WOMEN’S SHOE SIZES
Full Length 1/8” Poron® w/ Heel Cushion
®
3-4
FFD
Full Length Accommodative 1/8” Poron® 1/8” Plastazote®
FFP
Full Length Accommodative w/ Heel Flange
FFPF
3/4 (Sulcus) Length Forefoot Split 3/32” w/Heel Cushion
FFDS
MEN’S SHOE SIZES
Full Length 1/8” Poron w/ Heel Cushion
®
7-8
9-10
11-12
QTY
FFL
3/4 (Sulcus) Length 1/16” Poron w/ Heel Cushion
®
5-6
8-9
10-11 12-13 14-15
MFL
MFD
Full Length Accommodative 1/8” Poron® 1/8” Plastazote®
MFP
Full Length Accommodative w/ Heel Flange
MFPF
TOTAL
9.00
9.00
11.00
11.00
10.00
6-7
3/4 (Sulcus) Length 1/8” Poron w/ Heel Cushion
PRICE
9.00
9.00
11.00
11.00
HEEL PADS
SIZES
Fits Female
Fits Male
1/4” Poron® w/ Nylon Cover
S
M
L
XL
3-6
___
7-10
___
11-12
7-10
___
11-16
QTY
FFFHP
PRICE
TOTAL
9.00
BLUMAXX HEEL CUSHION
SIZES
Blumaxx Heel Cushion w/ Poron
®
S
L
XXXBMH
QTY
PRICE
TOTAL
12.00
TERMS AND CONDITIONS
•
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•
•
•
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Credit Terms – Net 30 days
Shipments – F.O.B. St. Louis, Missouri. Shipping is UPS Ground, unless express shipping is requested
Orders received prior to 3:00 pm CST are shipped the following day
Please allow 7-10 days for delivery of Ground Shipments
Returns must be authorized and received in original packaging within 30 days of invoice date. There is
a 15% re-stocking charge on items exchanged or returned for credit.
No returns will be accepted after 30 days
Please allow at least 2 additional business days for manufacturing of special orders
Revised 10/01/02