To enable us to either fax or mail you the appropriate order forms/samples, please fill in the information below.
Name (First & Last):
Clinic Name:
Address #1:
Address #2:
City: State: Zip:
Phone: Fax:
Email Address:

Request Order Form(s) For:

  
Back Specialist (Davis, Duncan, Health Care)
Chiro-Manis (Barnes)
DC 101 (Kyro)
Electra/Elite/Mercury
Gemini (Kyro)
Leander
Lloyd Benches 		Lloyd Table (Galaxy, Astro & McManis)
Relax-O
Spinalator
Titan
Zenith
Zenith-Cox
Other (please specify)


Fabric Samples Requested:
 

Levante' Premium Vinyl:
Full Chart or
Specify larger samples of: (list colors from palette)

DuraTouch "The Leather Alternative":
Full Chart or
Specify larger samples of: (list colors from palette)

Cloth Fabric (Full sample chart is not available):
Specify larger samples of: (list colors from palette)

 


Our Cover and Cushion sets are all custom tailored for the individual customer. They are custom made to your specifications and are NOT RETURNABLE, so please be sure of your color selection before ordering. Larger samples of any of our of fabrics are available upon request.
Allow two (2) weeks from receipt of order for Complete Cushion Sets to ship.
Do-It-Yourself Upholstery Kits ship within three (3) business days of receipt of order.