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Demo Sale Request Form

Thank you for your interest in our Demo Product Sale.
Please fill in the form below and we will contact you with special pricing.
If you need immediate assistance, please call toll free at 800-706-9255

Tell us how to get in touch with you:
* Required
First Name *
Last Name *
Company 
Street Address *
Street Address 2
City *
State * Zip  
Phone *
FAX
E-Mail

I am a:
Homecare Provider   Rehab Provider
PT/OT Caregiver Patient

Check the products which are of interest to you.
Ped Walker
Adult Walker
Bariatric Walker
Ped Stander
Ped Bathing Chair
Ped Seating & Positioning System
Ped Stroller
Ped School Chair

Comments or questions?

 

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