Individual Adaptive Clothing Request

We do our best to fulfill your order as listed from available stock on hand. Substituitions may be sent.
Name (First and Last)(required):Enlistment Date (required):
Shipping Address (required):
Shipping Address 2:
Shipping Address 3:
City (required):State (required):Zipcode (required):
Phone (required):Email (required):

Shorts / Pants See pictures of our clothing

Show Pants adapted in which way?   Left   Right   Double   Wheel Chair  
Please Limit quantity to 1 set of undergarments (4 pairs come in a set) and 2 or less items in the other rows.
Elastic waist & snap closureSmallMediumLargeXlargeXXLargeXXXLarge
Fits Waist Sizes:28"- 31.5"32"- 35.5"36"- 39.5"40"- 43.5"44"- 47.5"48"- 51.5"
 Adaptation
BoxersLeft
BoxersRight
BoxersDouble
Athletic ShortsOnly offered
in Double
Lounge PantLeft
Lounge PantRight
Lounge PantDouble
FixatorLeft
FixatorRight
FixatorDouble
Swim TrunksLeft
Swim TrunksRight
Swim TrunksDouble
Wheelchair Lounge Pants Quantity
These are special order
Please list your waist
and inseam measurements
and allow 3 wks for delivery.

Shirts See pictures of our clothing

Show Shirts adapted on which side?   Left   Right   Double  
Please Limit quantity to 2 or less per row.
 SmallMediumLargeXlargeXXLargeXXXLarge
Fits Chest Sizes:34"- 37.5"38"- 41.5"42"- 45.5"46"- 49.5"50"- 53.5"54"- 56.5"
 Adaptation
T-shirt - TorsoLeft
T-shirt - TorsoRight
T-shirt - TorsoDouble
Long Sleeve Shirt- TorsoLeft
Long Sleeve Shirt- TorsoRight
Long Sleeve Shirt- TorsoDouble
Polo Shirt - TorsoLeft
Polo Shirt - TorsoRight
Polo Shirt - TorsoDouble
Please indicate either short or long sleeve, neck size, and sleeve length if ordering long sleeves.
Dress Shirt (velcro under buttons)Quantity Short Sleeve
Long Sleeve
Neck Size:
Sleeve Length:

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