Abdominal Binder Order Form

Submitting this order form involves the following steps:

1. Complete this form.
2. Provide waist measurement and desired height of binder (we manufacture 8 different heights of binder: 4", 5", 6", 7", 8", 9", 10" or 12"). Please refer to the previous page for instructions on taking anatomical measurements.
3. Review and comfirm your total.
4. Complete the payment information with the PayPal billing service.

Any order completed on the weekends will be processed Monday.

Please note, all Canadian orders must be processed with our operators over the phone ( 913-755-6506 ).

* First Name

* Last Name

* Street Address

Address Line 2

* City

* State

* Zip Code

* Phone Number

* Email Address

* Waist Size:

* Height Size:

The Abdominal Binder is $18 plus $5 for shipping and handling (USD).

If you are Physical Therapist ordering a set below, then please enter an “x” for the waist size box.

* Item Quanity

Custom Abdominal Binder ($23 per binder)

Customize Your Binder Set
If the binder set you choose does not have the exact sizes that you
would like to order, simply select the set that is closest to the sizes
you would like, and then please state the sizes (for example: 4" x 18"
5" x 24", 6" x 32") in the comment section of PayPal called
"Add special instructions for the Merchant".

Abdominal Binder Set

For Physical Therapist (3 binders)

The Small Set is $45.00 + $6.50 Shipping and Handling (Total $51.50)
The Large Set is $45.00 + $6.50 Shipping and Handling (Total $51.50)

Small Set 4" X 21" - 5" X 26" - 6" X 29"

Large Set 7" X 29" - 8" X 31" - 10" X 33"

If the sizes of these sets do not match your needed sizes, then please fill in the exact sizes needed in the comment box in PayPal called "Add special instructions for the Merchant".

Shipping Address
Please enter the ship-to address. If the ship-to address is the same as above, then leave blank.

First Name

Last Name

Street Address

Address Line 2

City

State

Zip Code

Phone Number

For questions or problems with checkout please speak with one of our operators at (913) 755-6506 Business hours 8:00 to 3:00 central time.

                           No PayPal Account? No Problem.

                           you can pay through PayPal with your Credit Card

                                          (No PayPal account necessary)

* Indicates Response Required