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Order Form
Kozy Kovers


Wheelchair Covers | Wheelchair Skirts | Matching Sets | Walker Totes | Lap Covers | Order Form

Please fill in your order and print before pressing SUBMIT. Then mail the order form with your payment to our address below.

Full Address
Phone Number
Shipping Address
Who are you buying for?
What are their hobbies/interests?
Date of Order
$75 Wheelchair Cover/QTY
$40 Wheelchair Skirt/QTY
$100 Wheelchair Cover & Matching Skirt/QTY
Cover and Skirt Color
$25 Lap Cover with pockets/QTY
Lap Cover Color
$15 Walker Totes/QTY
$10 Water Bottle Holders/QTY
Payment Method
Total Due

NOTE: colors and prints may vary due to fabric availability.
Shipping and handling are included in pricing.

Mail your order along with payment to
Kozy Kovers
12632 SE 68th Place
Bellevue, WA 98006.