FAX OR MAIL ORDER FORM

Use this form to place orders on any of the products listed on our Catalog Pages by fax or by regular mail.
Follow these steps to order by mail:
  • Print this page or click on "PRINT PAGE" to open up a printable Word document. This will open MS WORD and then the document itself for printing and faxing/mailing.
  • Print this form
  • 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) / 205XXS :: XX Small - A8" x B13.5" x C8" (upper arm & lower leg) / $125.00 /
Limb Covers (double thickness) / 205XS :: X Small - A10" x B15.5" x C8" (upper arm & lower leg) / $125.00 /
Limb Covers (double thickness) / 205S :: Small - A10" x B17.5" x C8" (upper arm & lower leg) / $135.00 /
Limb Covers (double thickness) / 205M :: Medium - A12" x B19.5" x C12" (upper leg) / $145.00 /
Limb Covers (double thickness) / 205L :: Large - A13.5" x B21.5" x C12" (upper leg) / $165.00 /
Limb Covers (double thickness) / 205XL :: X Large - A15.5" x B23.5" x C12" (upper leg) / $185.00 /
Limb Covers (double thickness) / 205XXL :: XX Large - A17.5" x B25.5" x C12" (upper leg) / $215.00 /
Tendinitis Mitt / 380 :: Small - Medium Large XLarge / $95.00 /
Boots (double thickness) / 305 :: Small - Medium Large XLarge / $155.00 /
Lower Back Belts / 390 :: XSmall Small Medium Large / $145.00 /
Lower Back Belts / 390XL :: Extra Large XXLarge / $165.00 /
Wraps & Blankets Small / 100S :: 12" x 30" / $70.00 /
Wraps & Blankets Medium / 100M :: 20" x20" / $70.00 /
Wraps & Blankets Large / 100L :: 34" x 29" / $145.00 /
Wraps & Blankets Extra Large / 100XL :: 34" x 58" / $260.00 /
Long Sleeve Jackets Small / 425S :: Small / $575.00 /
Long Sleeve Jackets Medium / 425M :: Medium / $655.00 /
Long Sleeve Jackets Large / 425L :: Large / $775.00 /
Short Sleeve Jackets Small / 405S :: Small / $375.00 /
Short Sleeve Jackets Medium / 405M :: Medium / $425.00 /
Short Sleeve Jackets Large / 405L :: Large / $475.00 /
Faraband Double Layer General Purpose Wrap Small / 600S :: 42cm x 9 cm (16.5" x 3.5") / $29.50 /
Faraband Double Layer General Purpose Wrap Large / 600L ::150cm x 9 cm (59" x 3.5") / $115.00 /
Knee/Elbow Wrap Small / 500S ::Small / $135.00 /
Knee/Elbow Wrap Medium / 500M :: Medium / $135.00 /
Knee/Elbow Wrap Large / 500L :: Large / $14500 /
Knee/Elbow Wrap XLarge / 500XL :: Extra Large / $14500 /
Mitt / 350 :: Small:: - Medium Large / $135.00 /
Thigh Wrap Small / 150S :: Small / $140.00 /
Thigh Wrap Medium / 150M :: Medium / $160.00 /
Thigh Wrap Large / 150L ::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 theFARABLOC 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:
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.

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
CanadaV3B 6B4
A replacement product will be supplied after Farabloc has confirmed the product has a manufacturer's defect.

Return Policy

All sales are final. Farabloc accepts only warranty related returns (please see above).