PURCHASE ORDER
It is
very important
that you refer to
Measurement Procedure & Self-Measurement Notes
before ordering.
CANE MEASUREMENT PRESCRIPTION
Date
Cane User
Phone
Your Email Address
Indicate self-measurement option
Cane User weight
lbs.
kg.
Cane User height
in.
cm.
Cane Length
in.
cm.
Palm Width
in.
cm.
Indicate
Left
Right
Handle Type
Basic
Collectible
Wood Type
Custom-made Tiagra
Price
US $
Quantity
FREE SHIPPING WITHIN
CONTINENTAL USA
NY residents add 8.25% sales tax
Click on
continue
to select your payment method.
Click
here
for a printable PDF version of this order form.
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