Mail (or fax) Order Form Please, make checks payable to Ames Walker Intl., mail with the Order Form for fulfillment to:
Ames Walker Intl., PO Box 1027, Asheboro NC, 27204  Fax 1-336-629-0632
RxFit PRODUCTS SHIP FROM OUR WAREHOUSE IN 24-48 hours.  Jobst, Sigvaris, Medi, Juzo, Venosan,  ship from our warehouse in 2-3 Business Days.
Description, Color Item No.  Size Quantity Unit Price

Total $ US
1. #     $ $
2. #     $ $
3. #     $ $
4. #     $ $
5. #     $ $
SHIPPING & HANDLING: US Mail $2.99 on orders up to $49.99. Free on orders over $50 to USA and Canada, First Class Mail Only  $4.95 for Priority Mail 2-3 Days USA and military bases; 2nd Day UPS $14.95 USA only   Add appropriate  shipping expense     >>   $
TOTAL DUE (Charge Amount or check amount) $
Please, provide sufficient information so that we may properly process your order without delay.
Full Name>  
Full Street address or P.O. Box>  
City, St. Zip Code>  
Telephone>  
E-Mail Address>  
PAYMENT INFORMATION: We accept Visa, MasterCard, American Express, Discover, or mail your Check / Money Order payable to the Ames Walker Intl.
Cardholder Name  
Credit Card Number [Visa, MC, Amex, Discover]  Expiration Date>  
Signature
Comments or Special Requirements:

                                                                                                           Thank You for Your Order!