Order Form

Welcome to our online order form! To order any of our products, simply fill out the form below, and click on the "submit order now" button at the bottom of the page (this requires a forms-capable web browser). Please remember to include a phone number where you can be reached so that a sales representative may contact you to verify your credit card information, and to assist you with obtaining the correct size (if applicable). Alternatively, you may place your order by telephone by calling (800)532-3787. You may also print out this form, fill in the appropriate information, and FAX it to (800)661-7308. If you have any questions about our product line and would like a professional consultation with our staff podiatrist, please email your question(s) to consult@footandankle.com.

NOTE: we offer MANY other foot & ankle related products that are not listed in the online catalog, so if you are looking for a specific product, please call or email our order desk, and we will find the item that you are looking for. Thanks for shopping The Foot & Ankle Products Web Catalog!

Please enter the name and quantity of the product(s) you would like to order (one product per line, please):

Product:

Please enter your shoe size, if applicable (this is necessary for orthotics, insoles, and ankle braces):

Size:

Please select a method of shipment. Shipping and handling charges are as follows per product: standard UPS=$10, UPS 2nd day=$20, COD=$20, Overnight=$30 (all prices are U.S. currency). In addition, 6% sales tax will be added to orders originating from the state of Florida.

Name:                          

Address:                       

City:                          

State:                         

ZIP:                           

Phone:                         

FAX:                           

Email:

Please select your credit card type (Visa or Mastercard):

Please enter your credit card number:

Number:

Please enter the credit card expiration date: 

Expiration(example:07/97):

Please enter the name that appears on your credit card:

Cardname:

Please feel free to enter any comments, questions, or suggestions!

Comments:

Thank you for your order! A sales representative will contact you if additional information is required.

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