Order Form
Please submit this order form via e-mail or first class mail:   TruStep Medical Corporation a division of Island Blu Outfitters International P.O. Box 7300 Jupiter, FL 33468 Email: islandblu@gmail.com
Date of Order________________________________________________________________   Name______________________________________________________________________   Mailing Address______________________________________________________________   ___________________________________________________________________________   Telephone___________________________________________________________________   Email_______________________________________________________________________   Please answer the following:   The name of the show where you saw TruStep:_____________________________________   Sex: ________Male           __________Female     __________Age      ____________Shoe Size   Activity Level: (i.e.: Light, Moderate, Athletic, etc.)   ______________________________________________________________________________   Please list any foot ailments you are experiencing:   ______________________________________________________________________________     Method of Payment            Payment Type:(Please circle)    Visa   MasterCard    American Express   Discover   Check   Money Order   Cardholder Name   _______________________________________________________  Card Number    _______________________________________________________   Expiration Date _______________________________________________________                                    Signature ___________________________________________________________                           Authorized Amount _________________________________________________________