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Print & Fax this order to The Brace Shop at:
1(954) 574-9343
Or Mail this order form along with a check or money order to:
The Brace Shop
4171 W Hillsboro Blvd.
Suite 10
Coconut
Creek, Florida 33073
Please include cost of shipping
Call Toll Free: 1-866-325-8045 to place an order with one of our
customer service representatives and to determine shipping charges for your
order. If the toll free number is not available call: 1-954-547-9250.
Qty Item No. & Description Price/Each Item Total
_____ _________________________________________ ___________ ___________
_____ _________________________________________ ___________ ___________
_____ _________________________________________ ___________ ___________
_____ _________________________________________ ___________ ___________
_____ _________________________________________ ___________ ___________
Merchandise Subtotal: ___________
Shipping/Handling: _____________
Total Price: _____________
Payment method: ____VISA ___MC ____AMEX ____Discover _____Check
Phone# of Bank issuing card (on back of card):_________________________
Card # __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ Exp:_____/_____
CVV2:______ What is CVV2?
PLEASE PRINT!
Name on Card___________________________________________________________
Billing Address (address at which you receive credit card bills):
_______________________________________________________________________
_______________________________________________________________________
Shipping Address (if different from above):
_______________________________________________________________________
_______________________________________________________________________
Email Address:(Required)_______________________________________________
Daytime Phone#:(Required)______________________________________________
Special Instructions: _________________________________________________
Thank you for your order.
Braceshops.com Home Page
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The
following shipping and handling rates apply to most
orders. These rates may be different for large quantity
orders so call us toll free if you have any questions
concerning large bulk purchases (866-325-8045):
UPS
Ground : Free with purchases over $100.00
UPS
Ground (Continental US Only): $7.50
UPS
3 day: $15.00
UPS
2 day: $25.00
UPS
Next Day Saver: $39.00
UPS
Next Day (Before 10:30AM): $50.00 Call for this
special shipping requirement.
USPS
Priority Mail (Including APO, AE, HI and AK): $8.50
USPS
Global Express Canada & Fed Ex Canada: $39.00
Global
Express Mail International & Fed Ex International (All overseas orders
except Canada): $39.00-$85.00
UPS & Fed Ex
International Rates are available by calling toll free: 866-325-8045