Replacement Parts List
NOTE: If requested color is not available, similar color will be substituted.
Prices are subject to change.
Part Cost Qty Total Cost
Pad Set ...........................$15.99 ..........___ ........................ $_______
Belt Positioning Clip ............$.99 ..........___ ........................ $_______
Instructions .......................$0.00 ..........___ ........................ $_______
Merchandise Total...................... ...............................$_______
Shipping and handling:.............. ...............................$_______
Sales Tax ...................................................................$_______
(Arizona, California, Georgia, Indiana, Missouri, South Carolina, and Texas residents add
applicable sales tax.)
Grand Total ................................................................$_______
No shipping and handling on instructions for quantities under 6. Add $.50 for each instruction
over 6, then add applicable shipping and handling.
Fill Out For Credit Card
Visa Mastercard
Card Exp. Date:_______________________________________
Cardholder’s Name:____________________________________
Card Number:_________________________________________
Signature: ___________________________________________
Up to $25.00 ............. $5.95
$25.01 to $50.00 ......$6.95
$50.01 to $75.00 ......$8.95
$75.01 to $100.00 .... $9.95
$100.01 to $150.00 .. $10.95
$150.01 to $200.00 .. $11.95
$200.01 and up ........$13.95
Outside Continental USA $10.00
4358-6023 boostapak.indd 1-24358-6023 boostapak.indd 1-2 8/31/12 1:05 PM8/31/12 1:05 PM
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