Mail-In Order Form

Scrubs Made Special
229 Scioto St
Urbana, Oh 43078
1-800-628-1362

Name _______________________________________________________________

Address _____________________________________________________________

City, State, Zip _______________________________________________________

Phone _________________________________

In case we have a question about your order we will call you.

Please circle rise and leg you desire
1-4 inches may be added to the hem and sleeve length

Qty	Item #	Color	Size	Reg Rise	Low Rise	Straight Leg	Flare Leg	Price each	Total
Qty	Item #	Color	Size	Hem	Sleeve			Price each	Total









				7.25% Sales Tax for Ohio Residents Only Please make checks or money orders payable to: Scrubs Made Special				Subtotal Shipping Oh Tax Total

Shipping
Up to 53.00            8.50
53.01-80.00           9.75
80.01-120.00        12.50
120.01-200.00      15.00
200.01-Up             18.00