ORDER FORM
AFO CARVING BLANKS
25 B PROGRESS AVE.
NASHUA, NEW HAMPSHIRE 03062
WWW.SPINALBRACES.COM
To Place an order: 800.233.0356 ( Voice )
800.233.0357 ( Fax )
Production Order #
Date Required ________________
Date _______________
BILL TO: ( ___ ) ________________________
Ship To: _____________________________________________
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Customer: ______________________________
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P.O. #
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Contact:
Time:
❑ UPS Regular ❑ Orange (3-Day) ❑ Blue ( 2-Day) ❑ Red ( Next Day Air) ❑ FedEx Priority ❑ Standard ❑ Economy ❑ Other ____
AFO CARVING BLANKS TRAPEZOID SHAPE
Quantity
L
ML
AP
Top
11-200414
20”
4”
6”
14”
11-200614
20”
6”
6”
14”
11-200716
20”
7”
8.5”
16.5”
11-220616
22”
6”
6.5”
16.5”
11-220816
22”
8”
8.5”
16.5”
11-221014
22”
10”
10”
14”
11-240716
24”
7”
8.5”
16.5”
Item No.
Density*
AP
Bottom
* Please indicate 4 or 6 for 4lb or 6lb foam
Specify Mandrel Type: _________________________________________________
OR
Specify Mandrel Bore Diameter : _________________________________________
Specify Mandrel Bore Length : ___________________________________________
Unit Price
Amount