Hip Helpers Custom Order Form to print and send

Hip Helpers, Inc.
1332 Holly Point Rd.
Virginia Beach, VA 23454 USA
(757) 481-2407 (9 am to 5 pm ET M-F)
info@hiphelpers.com

Order Form For Custom Sizes
Please fill out, print, and mail to the address above. For international orders, see the shipping/handling charges below, and contact us before ordering if you have any questions.

Order Only Custom Sizes Here: For Standard Sizes use Order Form For Standard Sizes.
Before filling out form, please see Sizing Guide and Measurement Guide, and measure in inches.

This form is for payments by check/money order.
For credit card/electronic payment use Online Order Form.

Your Name
Address
City
State		Zip
Phone (include area code)		Email

Measurements			Color	Quantity	Total (Quantity x $22)
Waist	Hip	Length	Color	Quantity	Total (Quantity x $22)




Please indicate alternate color choice(s)
Sizing Kit(s) @ $65.00 each
DVD videos @ $6.00 each
US Shipping/handling: Add $3 first pair, $1 for each additional pair, $5 per Sizing Kit, $3.50 per DVD. Global shipping/handing: Add $30 for 1-6 pairs, $27 to Canada and Mexico.
Virginia Residents add 5% sales tax:
TOTAL:

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