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The Foot
Lift Assist is concealed by the garment.
We welcome
your inquiry and invite you to try the Foot Lift Assist and see what a
difference it can make in your life.
Mobility Now
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Print this form. Mail the completed form to:
Mobility Now
N8425 Sunny Point Road
Beaver Dam, Wisconsin 53916
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Mobility Now
Foot Lift Assist |
Order Form |
Date: |
| Name |
|
| Address |
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| City, State, ZIP |
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| Telephone |
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Fill in this
information-- |
| Left Foot _______ |
Right Foot ______ |
Both ______ |
| Men's Shoe size_____ |
Women's Shoe size_____ |
Waist Measurement_____ |
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Shoe sizes vary: Please measure the circumference of the shoe you
will be wearing. Encircle the shoe with your tape measure at the
widest part of the shoe. This will be the ball of the foot area.
This measurement is essential. Circumference:_________ |
Prices effective July 24, 2008
| Unpadded Belt Units (to be used with belt loops) |
U.S. prices |
| Foot Lift Assist with unpadded belt |
$59.95 |
| 2 Lifts (1 for each leg) with unpadded belt |
$82.95 |
| Shipping and Handling
(Charge will increase if necessary.) |
$6.00 |
| Recommended: Padded Belt Units |
U.S. prices |
| Foot Lift Assist with Customized padded belt |
$63.95 |
| 2 Lifts (1 for each leg) with Customized padded belt |
$86.95 |
| Shipping and Handling (Charge will increase if necessary.) |
$6.00 |
Wisconsin Residents Only:
5% or 5.5% Sales Tax, depending on the county
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