ORDER FORM:      DIABETIC AND COMFORT SOCKS

* PAY BY CHECK (the safest way) COPY THIS ORDER FORM AND MAIL TO:
Diabetic and Comfort Socks   P.O. Box 703   Port Orchard, Wa.  98366
 
 NAME______________________________ADDRESS_________________________________________
 
CITY_________________________STATE______ZIP_____________PHONE______________________
 
INFORMATION CALL: 360-876-8363 
 
 
 
STYLE # 1 THERASOCK (double sock system)
Crew $12.95 In Colors:  White-Black-Brown-Navy     Mini Crew $11.95  Color: White

Shoe Size
Men
Women
Color
Many
Total
Sm.
3-5
4-6
.
.
.
Med.
5-8
6-9
.
.
.
Lg.
8-11
9-12
.
.
.
X-Lg.
11-14
12-15
.
.
.

STYLE # 2  THERASOCK (wide double sock system)  CREW $12.95  Colors: White-Black

Shoe Size
Men
Women
Color
Many
Total
Med.
5W-7W
5W-8W
.
.
.
Lg.
9W-11W
9W-12W
.
.
.
X-Lg.
11W-14W
12W-15W
.
.
.

STYLE # 3   SMARTKNIT (seamless)  Crew $12.95 Each or 3/$37.50 or  6/$72.00 Colors: White (Black  and Grey see style # 6)
Mini-Crew $11.95  Colors:White

Shoe Size
Men
Women
Color
Many
Total
Sm.
5-7
5-8
.
.
.
Med.
8-10
9-11
.
.
.
Lg.
11-13
12-14
.
.
.
X-Lg.
13-15
.
.
.
.

STYLE # 4  CARE SOX PLUS    CREW $10.95 EACH    COLOR: WHITE

Shoe Size
Men
Women
Color
Many
Total
Sm.
4W-6W
5W-7W
.
.
.
Med.
7W-9W
8W-10W
.
.
.
Lg.
10W-12W
11W-13W
.
.
.
X-Lg.
13W-15W
.
.
.
.

STYLE # 6  SMARTKNIT SEAMLESS X-STATIC SOCKS  $13.50 Colors: Grey-Black   Mini-Crew Color Grey $12.50

Shoe Size
Men
Women
Color
Many
Total
Sm.
5-7
5-8
.
.
.
Med.
8-10
9-11
.
.
.
Lg.
11-13
12-14
.
.
.
X-Lg.
13-15
.
.
.
.

STYLE # 7  Smartknit Seamless X-Static Wide Sock System  Color: Black $13.50 a pair White in Smartknit

Shoe Size
Men
Women
Color
Many
Total
Sm.
5-7
5-8
.
.
.
Med.
8-10
9-11
.
.
.
Lg.
11-13
12-14
.
.
.
X-Lg.
13-15
.
.
.
.

STYLE # 10 Comfort System Lite Crew $8.95 Colors:White,Black,Navy,Brown. Mini-Crew $7.95 Color White

Shoe Size
Men
Women
Color
Many
Total
Sm.
4-6
5-7
.
.
.
Med.
6-9
7-10
.
.
.
Lg.
9-12
10-13
.
.
.
X-Lg.
12-15
13 and up
.
.
.

STYLE # 11  Comfort System Plus Crew $9.95 Colors:White,Black Navy,Brown. Mini-Crew $8.95 Color White

Shoe Size
Men
Women
Color
Many
Total
Sm.
4-6
5-7
.
.
.
Med.
6-9
7-10
.
.
.
Lg.
9-12
10-13
.
.
.
X-Lg.
12-15
13 and up
.
.
.

Style #  7  Diabetic Foot Cream
.
How Many        Total: Call for Pricing
Style #  8  Diabetic Hand & Body Cream
.
How Many         Total:Call for Pricing

                                                                                         SUB  TOTAL__________________
                                   Washington Residents Pay 8.6% Sales Tax__________________
                                                                     Shipping call for pricing__________________ 
                                                                                                 TOTAL___________________                                           

QUESTIONS E-MAIL

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