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


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 closureSmallMediumLargeXlargeXXLarge
Fits Waist Sizes:28"- 31.5"32"- 35.5"36"- 39.5"40"- 43.5"44"- 47.5"
 Adaptation
BoxersDouble
ShortsDouble
Lounge PantDouble
Special Request Pants Please allow 3 weeks for delivery.
Fixator
Pants
Quantity:

Waist:


Side Adaption: Left
Right
Double
Fixator Position: Upper
Lower
Fixator Diameter:
(We stock 36)
Wheelchair Pants Casual Lounge Quantity:    
Formal Dress Quantity:   
These are special order. Please list your waist and inseam measurements and allow 3 wks for delivery.
Comments for
Special Request:

Shirts See pictures of our clothing

Please Limit quantity to 2 or less per row.
 SmallMediumLargeXlargeXXLarge
Fits Chest Sizes:34"- 37.5"38"- 41.5"42"- 45.5"46"- 49.5"50"- 53.5"
 Adaptation
T-shirt - TorsoDouble
Long Sleeve Shirt- TorsoDouble
Comments: