Musmate Products Order Form for the USA  
Product Harness Size Shoe Size Quantity Price ($) Total
Complete Set for the Left Leg       197  
Complete Set for the Right Leg       197  
Complete Set for Both Legs       332  
Product Size Color Quantity Price (£) Total
Left Leg Shoulder Harness       86  
Right Leg Shoulder Harness       86  
Both Legs Shoulder Harness       110  
Shoulder Pad       9  
Elastic Assembly for the Left Leg       35  
Elastic Assembly for the Right Leg       35  
Shoe Harness for Left Foot       60  
Shoe Harness for Right Foot       60  
Shoelace Connector       9  
___________________________ ____________ _______________ _______ _______ _________
Delivery Charge (less than $150, $16; over $150, $32)  
Total_____________________________________________________________________ _________
Name:
Address:
Telephone Number (in case of queries):
E-mail Address (in case of queries):

Payment
Please make cheques payable to Musmate Ltd.

Send Payment to:
Musmate Ltd, P.O.Box 3976, Bath, Somerset, BA1 0DF, UK. Telephone 0845 094 4674, fax 0845 094 4674,
e-mail
sales@musmate.co.uk
A company registered in England and Wales, No. 5671724.