Order Form
Kozy Kovers
Home
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.
Name
Full Address
Phone Number
Shipping Address
Who are you buying for?
female
male
child
What are their hobbies/interests?
Date of Order
Size
small
medium
large
skirt size fits all
$75 Wheelchair Cover/QTY
$40 Wheelchair Skirt/QTY
$100 Wheelchair Cover & Matching Skirt/QTY
Cover and Skirt Color
red/print
blue/print
green/print
yellow/print
$25 Lap Cover with pockets/QTY
Lap Cover Color
solid
print
plaid
$15 Walker Totes/QTY
$10 Water Bottle Holders/QTY
Payment Method
check
money order
cashier's check
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.
Please contact us with any questions or comments.