FAX OR MAIL ORDER FORM - PRINT PAGE

Use this form to place orders on any of the products listed on our Catalog Pages by fax or by regular mail.

Fax to: 604 941-8065. Phone Toll Free:1-866-941-4711 for support.


Follow these steps to order by mail:

  • Print this page ( Ctrl P or File/Print)
  • OR
  • Click on "PRINT PAGE" to open up a printable Microsoft Word document. This will open MS WORD and then the document itself for printing and faxing/mailing. Print Word Document.
  • Complete the form specifying product and quantity
  • Include complete payment (product(s) total, S & H charges, and sales tax for WA residents - see below)
  • Send to the address specified at the bottom of the form.

Note: Please list a company name if this is a business purchase, as well as a street address for shipping purposes. Your personal or business information will be used for internal use only and will not be shared with other organizations or individuals.

Person Ordering

Full Name:   

Phone Number:  

Email Address:  

Shipping Address (no post office boxes please)

Company Name:  

Address Line 1:  

Address Line 2:  

City/Prov/State:  

Postal Code/Zip:  

 
 
Select the sizes and quantities of each item:
 
ITEM DESCRIPTION PRICE QUANT

 
Limb Covers (double thickness) XX Small - A8" x B13.5" x C8" (upper arm & lower leg) $125.00
Limb Covers (double thickness) X Small - A10" x B15.5" x C8" (upper arm & lower leg) $125.00
Limb Covers (double thickness) Small - A10" x B17.5" x C8" (upper arm & lower leg) $135.00
Limb Covers (double thickness) Medium - A12" x B19.5" x C12" (upper leg) $145.00
Limb Covers (double thickness) Large - A13.5" x B21.5" x C12" (upper leg) $165.00
Limb Covers (double thickness) X Large - A15.5" x B23.5" x C12" (upper leg) $185.00
Limb Covers (double thickness) XX Large - A17.5" x B25.5" x C12" (upper leg) $215.00
Tendinitis Mitt Small - Medium Large XLarge $95.00
Boots (double thickness) Small - Medium Large XLarge $155.00
Lower Back Belts XSmall Small Medium Large $145.00
Lower Back Belts Extra Large XXLarge $165.00
Wraps & Blankets Small 12" x 30" $70.00
Wraps & Blankets Medium 20" x20" $70.00
Wraps & Blankets Large 34" x 29" $145.00
Wraps & Blankets Extra Large 34" x 58" $260.00
Long Sleeve Jackets Small Small $575.00
Long Sleeve Jackets Medium Medium $655.00
Long Sleeve Jackets Large Large $775.00
Short Sleeve Jackets Small Small $375.00
Short Sleeve Jackets Medium Medium $425.00
Short Sleeve Jackets Large Large $475.00
Faraband Double Layer General Purpose Wrap Small 42cm x 9 cm (16.5" x 3.5") $29.50
Faraband Double Layer General Purpose Wrap Large 150cm x 9 cm (59" x 3.5") $115.00
Knee/Elbow Wrap Small Small $135.00
Knee/Elbow Wrap Medium Medium $135.00
Knee/Elbow Wrap Large Large $14500
Knee/Elbow Wrap XLarge Extra Large $14500
Mitt Small::  - Medium Large $135.00
Thigh Wrap Small Small $140.00
Thigh Wrap Medium Medium $160.00
Thigh Wrap Large Large $180.00

Amputee Limb Cover Measuring

A: circumference at the point of amputation

B: the larger circumference along the limb

C is the distance you want the FARABLOC cover to extend along the limb.

Made-to-Measure Amputee Limb Covers

 

  • If none of the sizes below fit your needs, you will need a Made-to-Measure garment.

  • To have it Made-to-Measure please call our office
    toll-free 1 -866-941-4711 or 604-941-8201.

Send Your Order To:

Farabloc Development Corporation
211-3030 Lincoln Avenue
Coquitlam, British Columbia
Phone: 604 941-8201
Fax: 604 941-8065 or
EMail: info@farabloc.com

Shipping Charges and Taxes

We arrange shipping to any destination within North America for the cost of $10.00 per item. Purchases outside of North America will be shipped for a cost of $20.00. Extra charges may apply for some countries and you will be advised prior to shipping. If requested, courier or express delivery can be arranged at rates currently in effect. Orders are typically shipped within 48 business hours of receipt of your order. Please allow 2 weeks for delivery.

Warranty

All of our products include a one year warranty against manufacturer's defects only.

Return Policy

Because of production costs there will be a 15% restocking fee on all returns unless there were sewing defects or shipping errors. We need to be notified of the return & give you a Return Number so we can track the shipping. All blankets & other items will require an inspection & must be clean on return.

Returns - Warranty Claim
To make a warranty claim, return the defective product during the warranty period to:

Farabloc Development Corporation,
211-3030 Lincoln Avenue, Coquitlam, British Columbia
Canada V3B 6B4

A replacement product will be supplied after Farabloc has confirmed the product has a manufacturer's defect.

Shipping & delivery
We arrange shipping to any destination within North America for the cost of $10.00 per item. Purchases outside of North America will be shipped for a cost of $20.00. Extra charges may apply for some countries and you will be advised prior to shipping. If requested, courier or express delivery can be arranged at rates currently in effect. Orders are typically shipped within 48 business hours of receipt of your order. Please allow 2 weeks for delivery.

Payment
We accept Visa, MasterCard and American Express. Your credit card is not charged until your order ships. We are required to collect Provincial sales tax (7%) for orders within British Columbia, Canada and GST (7%) for orders shipped anywhere within Canada.