Order Form
Color
Qty
Style
Price per Pouch
Total
.
Complete Lacy Elegance
Top Lacy Elegance
Simple Pleasures
Whimsical
La Poche
Generic ABC
Feeding-Tube Pocket
Pouches will be made with an open bottom, a clip pocket, and an elastic flange unless requested otherwise.
Illinois Residents add 7.1% tax
S&H for 1-5 covers - or -
$2.00
$4.00
Total Enclosed
Send Check or Money Order to:
Pouch Pals--The highest quality, competively priced, custom-fit ostomy pouch covers that one can buy!