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Order Form

Support Leg Assistant

(Patent Pending)

Ordering is easy.
For check and money orders, print out the form below and mail to:


Jerry Giralde

3212 W. Floradora Ave

Fresno CA  93722


 

Type of payment: Check ____ Money Order ___

Price of Support Leg Assistant                   $225.00

Sales tax (CA Residents)                          $_____

Shipping and Handling UPS Ground          $ 25.00

Shipping and Handling UPS 3 day             $ 45.00

Total  Enclosed                                                 $_________


(Parcel Post or UPS for Continental U.S.)
Ship to: Name___________________________
Address______________________________
City______________________________
State_______, Zip______________