APTEI™ Essential Clinical Supplies

"Committed to patient care by providing high quality clinical products to maximize Physical Therapy evaluation and treatment effectiveness."®

Please Print & Complete This Order Form

and Fax or Mail it to APTEI E.C.S.

Tel & Fax: 905-707-0819

44 Sea Island Path, Thornhill, Ontario, CANADA L3T 3A4

Full name_______________________________________________ (Please print clearly)

Mailing address_____________________________________________ Suite #: ______

City: _________________ Province: _______________ Postal code: ________________

Contact Telephone Number_(____)_________________ Fax_(____)________________

Note: All prices are in Canadian Dollar.

Note: For more information on the products listed below, please visit the APTEI Clinical Library in this web site

Name of Product	Code #	Quantity	Unit Price	Total
q 1 roll of Cover Roll Stretch (White) (Minimum order: 5)	01005		$10.00	$
q 1 roll of Leukotape (Brown) (Minimum order: 5)	01004		$10.00	$
q A Therapeutic Taping Manual & DVD (highly recommended) or VHS	099		$95.00	$
q AMG Hand Held Sphyg. (Muscular Retraining Biofeedback Device): Includes two (2) bladders + An Instructional Video	01001		$129.00	$
q Mobilization Belts (Saunders 96	SA-08096		$20.00	$
q PRONEX Cervical Traction Unit (Canada Only&Please contact for pricing)	01002		$1.00	$
q Saunders Cervical Home Traction Unit	100399		$695.00	$
q Saunders Lumbar Home Traction Unit	101099A		$725.00	$
q Saunders Mother-To-Be Maternity Support	32505 (S, M, L, XL)		$85.00	$
q Saunders Sacroiliac Belt (Medium: 32	08122M		$28.00	$
q Saunders Scaroiliac Belt (Large: 42	08122L		$28.00	$
q Saunders SI Stabilization Pad	08200R		$26.00	$
q STP Neck Exerciser	01005		$25.00	$
q Strassburg Plantar Fascia Sock	1212		$44.95	$
		Subtotal		$
		Shipping & Handling		$ 10.00
		8% PST (Ont. Only)
		5% GST
		TOTAL		$

Please mail in your payment if paying by cheque or simply fax in your order form if paying by Visa or Master Card.

r Cheque payable to: APTEI E.C.S.

r Visa # _________- _________- _________- _________ exp ____/ ____

r M/C # _________- _________- _________- _________ exp ____/ ____

Authorization Signature: ___________________________ Date: _______________________

"You and your patients satisfaction of our products is our greatest priority"

** Refunds or exchanges will be gladly provided within 30 days if the product is returned in a condition suitable for resale and in its original packaging.