Mail-In Order Form

Scrubs Made Special
229 Scioto St
                                                                                      Urbana, Oh  43078
                                                                                       1-800-628-1362

Name _______________________________________________________________

Address _____________________________________________________________

City, State, Zip  _______________________________________________________

Phone _________________________________

In case we have a question about your order we  will call you.

Please circle rise and leg you desire
1-4 inches may be added to the hem and sleeve length
 

Qty

Item #

Color

Size

Reg Rise

Low Rise Straight Leg Flare Leg

Price each

Total

Hem Sleeve    

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7% Sales Tax for Ohio Residents Only
Please make checks or money orders payable to: Scrubs Made Special


Subtotal

Shipping

Oh Tax

Total

 

 
 
 
Shipping
Up to 53.00              5.65
53.01-80.00             7.00
80.01-120.00           8.95
120.01-200.00        12.00
200.01-Up              15.00