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PERSONAL FORM BACK
Online quote form
Custermize & Buy
STANDARD SIZES
Please select Option
SHUF16 Gentle Fit Back 16" x 18"
SHUF18 Gentle Fit Back 18" x 18"
SHUFCW Form Fit Back - Gentle Lateral Custom Width (heigth = 18")
SHUFCH Form Fit Back - Gentle Lateral Custom height
SHUFC Form Fit Back - Gentle Lateral Custom
Gentle Fit Back Custom Width:*
Gentle Fit Back Custom Width:*
Please select Option
16"
18"
Gentle Fit Back Custom height:*
Gentle Lateral Custom:*
ADDITIONAL OVERLAYS
  
SHUFOLV1 Visco Overlay Half (3 Pieces)
SHUFOLV2 Visco Overlay Full (6 pieces)
SHUFOLG1 Gel Overlay Half (3 Pieces)
SHUFOLG2 Gel Overlay Full (6 Pieces)
PIN OPTIONS?
Please select Option
SHUFP1 1" Long Pins
SHUFP34 3/4" Long Pins
(Standard)
COVER OPTIONS
Please select Option
SHUFCOV1 Standard
SHUFCOV2 TEK4 Infection Control Complete Cover
SHUFCOV7 TEK4 Infection Control 4" Bottom Protector
EXTRA COVER*
  
SHUFCOV3 Standard Cover
SHUFCOV4 TEK4 Infection Control Complete Cover
SHUFCOV8 TEK4 Infection Control 4" Bottom Protector
SHUFCOV5 Custom Cover
*Note: Please enter the size above for standard or custom cover
Custom Cover:*
Please select Option
Standard
TEK4
Custom Cover sizes:*
*Note: Please enter the size above for standard or custom cover
Additional Notes
Final Total
First Name*
Last Name*
Company Name:*
Phone Number:*
Official Work Email*
Location:*
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