In order for Scott Aeromechanical Research & Development to better serve your needs, we must collect some basic information.  Items preceded by an asterisk ( * ) are mandatory information.  All information collected for this order is absolutely confidential and will never be sold to third-party vendors.  On submission of this form, please be prepared to receive a phone call from us to verify your order, information, and obtain your credit card number and expiration date for the sake of placing your order; a correct phone number is essential or we will not be able to complete your order, as we do not take credit card numbers over the internet as a matter security for you and of company policy.  Scott collects information and completes orders in this manner to ensure the safety of your information and the completeness of your order and, upon processing completion, the email we receive from you is removed from the computer the order is received on.  You may use the tab key to move from field to field.  Thank you.

NOTE: Please fill in all required fields with the appropriate information, or we will not be able to process your order.  Thank you.


*May we have your first and last name?

May we have your full address?
Street
City, State
Zip Code

*May we have your telephone number?


*May we have your email address?


Are you ordering Ostomy Armor™ for your Toddler?
No Yes
Cost of the Toddler Armor is $65.00

Which side is your stoma on?
Left Right
Cost of adult Ostomy Armor™ is $85.00

*What is your waist size? (indicate centimeters or inches)


What color would you like your Ostomy Armor™ to be?
SELECT HEAVY DUTY COLOR Red Blue Purple Military Green Gold Dull Black ---------- SELECT TODDLER ARMOR COLOR Military Green Purple Orange

Would you like to have the Extreme Comfort Belt sent as well, so you can wear the armor more comfortably?
No Yes
Cost of the Extreme Comfort Belt upgrade is $10.00

We would like to become your supplier for all of your ostomy needs.  If you would like us to become your one-stop shop, please tell us what you normally order, including their stock numbers and your normal quantity?


Would you like to share any comments with us, whether about our products or our web site?


   

IMPORTANT NOTES:
• We are able to take all major credit cards over the phone, and we work with PayPal, as well (gordon.scott@ostomyarmor.com).
• All of our ostomy supplies are 12% off retail all the time.
• Because each Ostomy Armor™ is custom made to your specifications, please allow 14 days after receipt of your payment for delivery.  Please allow extra time for modifications and special orders.
• Shipping is accomplished by United States Postal Service unless you request otherwise, at which time appropriate charges will apply.
• All international orders require an additional $20.00 for shipping & handling.
• Due to proximity to human waste and biohazard contamination we are not able to accept any returns.