JAECO
WREX Order Form
1
BILL TO:
Customer Name
Address
City
State
Zip
Phone ( )
Fax ( )
Your Name
2
SHIP TO:
Customer Name
Address
City
State
Zip
Attention
Department
3
Method of Payment:
Check
(Payable to JAECO Orthopedic)
Bill our Account:
Purchase order Number
Credit Card:
Visa
MasterCard
4
Shipping:
Ground 1-5 Days
3-Day
2
nd
Day Air
Next Day Air
5
Select WREX Arm:
Qty.
Product #
Product Description
JWREX-1L
WREX Arm Left
JWREX-1R
WREX Arm Right
6
Select WREX Forearm Support:
Qty.
Product #
Product Description
WFS-6
6 in. Pediatric
WFS-8
8 in. Small
WFS-9
9 in. Medium
WFS-10
10 in. Large
FSC-1
Custom: Supply measurements
Forearm Length
Wrist Circumference
Forearm Circumference
Custom Forearm Support Measurements
Credit Card Number:
Expiration date:
Printed Name:
Signature:
Date:
CC Billing Address
City
State
Zip
(501) 623-5944 * Fax: (501) 623-0159 * Email: [email protected] * Web: www.jaeco-orthopedic.com
4-10
Содержание WREX
Страница 1: ...Setup Instructions for WREX...
Страница 4: ...Section 1 Part Description...
Страница 7: ...Section 2 Mount Attachment...
Страница 21: ...Section 3 WREX Arm Setup...
Страница 25: ...Section 4 Fitting and Adjustments with Client...
