Quantity
Circle Weight Choice
Fabric Choice
Sub Total_______
Shipping_______
Neb Only Tax 7%_______
TOTAL_______
Check One: Check___  Visa___  Discover___  Master Card___  American Express____
Card Numbers:
Expiration Date: _______/________                  Security Code_______________
Name as it appears on card:

_____________________________     ____      _______________________________
Billing Address
Name
Street
 
City                                                       State                                             ZIP
Mailing address (If different from billing address)

Name_________________________________________________________________

Street_________________________________________________________________

City__________________________________State_______________Zip__________

Contact Person________________________________________________________

Phone Number________________________________________________________

Email     ______________________________________________________________

We do not share or keep your personal information. This information will be shredded.
USA SHIPPING
From 1.00
 To $ 114.00
 $10.00*
From $ 115.00
 To $ 149.00
 $15.00*
$150.00
 or more
 Free*
*Weighted Plush
   $10.00 each
*Weighted  Vest
   $10.00 each
CANADA SHIPPING
0.01
 20.00
 49.00
20.01
 40.00
 85.00
40.01
 60.00
 155.00
60.01
 80.00
 180.00
30.01
 or more
 Please Call
1 or 2 Vests: 49..00
 1 or 2 Plushes 49.00
each
 1 or 2 Dolls:  49.00
each
NO SHIPPING OUTSIDE USA & CANADA
 
Weighted Blanket
size Large
58 x 75
6  7  8  9  10  11  12  13  14  
15  16  17  18  19  20
 

$199.40
      
 
Weighted Blanket
size Tall
42 x 70
6  7  8  9  10  11  12  13  14  
15  16  17  18  19  20
  
$159.50
      
 
Weighted Blanket
size Average
42 x 60
6  7  8  9  10  11  12  13  14  
15
  
$139.50
      
 
Weighted Blanket
size Youth
42 x 50
6  7  8  9  10  11  12  13  14  
15
  
$114.00
      
 
Weighted Blanket
size Travel
42 x 42
5  6  7  8  9  10  11  12  13  
14  15
  
$95.00
      
 
Weighted Blanket
size Toddler
36 x 42
4  5  6  7  8  9  10  11  12  13  
14  15
  
$79.40
      
 
Weighted Blanket
size Shoulder
24 x 42
4  5  6  7  8  9  10
  
$52.00
      
 
Weighted Blanket size Lap
20 x 24
2  3  4  5  6  7  8
  
$40.60
      
 
 
 
 
 
      
 
Weighted Lap Pad
14 x 16
2  3  4  5  6  7  8
 
$25.00
      
 
Weighted Lap Wrap
9 x 30
2  3  4  5  6  7  8
  
$35.00
      
 
Weighted Shoulder Wrap
16 to 18 accross
2  3  4  5  6  7  8
  
$42.00
      
 
Weighted Plush
2  3  4  5
Item ID # from website________
$35.00
      
Shipping $10.00 each
 $10.00
      
WEIGHTED VESTS     Shipping $ 10.00 each
  
  Chest:   20    21    22    23    24    25
        26   27    28    29
Height_____  Weight_____
Style: V/F    V/B    R/F    R/B    R/E
 Fabric Choice:
 Embedded Weight
$129.00
      
Removable Weights
$159.00
      
Adjustable Sides
$30.00
      
  Chest:   30     31    32     33     34        
       35     36     37     38     39
Height_____  Weight_____
Style: V/F    V/B    R/F    R/B    R/E
 Fabric Choice:
 Embedded Weight
 $119.00
      
Removable Weights
$149.00
      
Adjustable Sides
$30.00
      
  Chest:   40     41     42     43     44
        45     46     47     48     49
Height_____  Weight_____
Style: V/F    V/B    R/F    R/B    R/E
 Fabric Choice:
 Embedded Weight
$139.00
      
Removable weights
---
      
Adjustable Sides
$30.00
      
  Chest:  50     51     52    53     54     55
Height_____  Weight_____
Style: V/F    V/B    R/F    R/B    R/E
 Fabric Choice:
 Embedded Weight
$159.00
      
Removable Weights
---
      
Adjustable Sides
$30.00
      
  RUSH!
 (Payment for overtime to ship your custom order
within 10 days)
$15.00
      
  Special Order
 Please call about special requests.  402-366-5883
 
      
Credit Card    /    Shipping Information               Please print clearly
Prices
Sub Total   Total
We honor Check, Credit Card or Purchase Order with authorized signature.
Salt of the Earth Weighted Gear - 1031 17th St - Henderson, NE  68371