International Order Form

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| Canadian | United States | International |

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QuantityItemPatternBeltUnit PriceTotal
   
   
   
   
   
   
   
   
   
   

Product Total:
Shipping and Handling details will be sent with your order confirmation.
All amounts are expressed in Canadian Dollars.

Payment will be made by: International Money Order Credit Card

Insulin Pump Make & Model:

Other Notes:

Ordering Notes

Receipt of order will hold product for two weeks. Product will be shipped upon receipt of payment.
Your order will be confirmed via the email you specified. If you do not receive a confirmation within three days, please email us directly.

If you are paying by Credit Card, you will receive a PayPal confirmation in a few days.


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Returns will not be accepted on custom orders.
Customers are responsible for any additional taxes or duties.

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