PRINTABLE ORDER FORM

Call (567) 226-8004 with questions.

NOTE: e-mail 'setz@rcscompany.com' for Ostomy Support Group or Distributor Pricing for all products listed!
Free shipping applies to all domestic orders, for orders outside the U.S. please contact us regarding shipping.

Qty. Item Price Per Item TOTAL
STOMA CUP
FREE with purchase of any size"Handi-Ring".
(For Cup only purchases, the following prices shown apply.)
1 @ $15.00
2 @ $12.50 ea.
3 @ $10.00 ea.

$

"HANDI-RING" #100
Must be used with Ostomy Belt and 1-1/2" pouch.
For stomas 1/2" to 1" diameter or irregular shape.

1 @ $33.00
2 @ $28.00 ea.
3 @ $25.00 ea.

$

"HANDI-RING" #125
Must be used with Ostomy Belt and 1-3/4" pouch.
For stomas up to 1-1/4" diameter or irregular shape.

1 @ $38.00
2 @ $33.00 ea.
3 @ $30.00 ea.

$

"HANDI-RING" #175
Must be used with Ostomy Belt and 2-1/4" pouch.
 For stomas up to 1-3/4" diameter or irregular shape.

1 @ $43.00
2 @ $38.00 ea.
3 @ $35.00 ea.
$

Please note: as all items listed are considered a personal medical product, we are unable to accept returns for replacement of another size.
Further: RCS Company is not a Medicare Provider and therefore does not bill Medicare. If you are a Medicare recipient you must assume complete financial responsibility for your RCS purchases.

Grand Total $

Please send my order to:
NAME:
EMAIL:
ADDRESS:
CITY:
STATE:
ZIP CODE:

NOTE: You may complete, print, and mail the order form with check or money order to: RCS Company,

P.O. Box 226, Bluffton, Ohio 45817-0226.

Thank you for ordering your RCS Co. products. Your order will be sent immediately.

 

If required, further information may be obtained by contacting the RCSCOMPANY via E-mail or U.S mail:

E-mail: setz@rcscompany.com
RCS Company
P.O. Box 226
Bluffton, Ohio 45817-0226


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