KNEESAVERS™ PEDAL ADAPTORS
PRINT OUT ORDER FORM

Date: _____________________

Quantity Item Price Total
__________ Kneesavers™ Pedal Adaptors ($45.00/pair plus $3 S&H)
        (Includes Right and Left spacers that fit between pedal and crankarm)
$45/Pair $__________
__________ Right Kneesaver™ Only $25/Each $__________
__________ Left Kneesaver™ Only $25/Each $__________
__________ Kneesavers™ For Stationary Bikes $45/Pair $__________
__________ Titanium Kneesavers™ Pedal Adapters $100/Pair $__________

Thread Size:

____ 20 mm   ____ 25 mm   ____ 30 mm (9/16" thread)

____ 20 mm   ____ 30 mm (1/2" thread)

__________ Pedal Adapters (20 mm) - 1/2" male end and 9/16" female end to convert stationary or spin trainer bikes to road pedal systems $45/Pair $__________
    Shipping & Handling $3.00/Pair - $2.00/Single $__________
    TOTAL $__________

ORDERED BY:

SHIP TO:

Name _________________________________________

Address _______________________________________

City/State/Zip ___________________________________

Phone (_____)___________________________________

Name _________________________________________

Address _______________________________________

City/State/Zip ___________________________________

Phone (_____)___________________________________


PAYMENT INFORMATION

Credit Card_______ Check _______

Credit Card # __________  __________  __________  __________

Expiration Date: __________

Name as it appears on the card: ___________________________________

Kneesavers™ help eliminate lower extremity pain for those cyclists with (1) toe-out condition, (2) large feet, (3) wide pelvis, (4) bowlegged structure, or (5) biomechanical/anatomical variation.

* Sorry, but there is a $30.00 fee for all returned checks.

MAKE CHECKS PAYABLE TO "SCOR PRODUCTIONS"
Add $7.00 for C.O.D.s.

SCOR Productions
P.O. Box 2466
Fallbrook, CA 92028
Phone # (800) 548-4447
Fax # (760) 728-0571

You may also order online.

(Credit Card charge or online ordering will appear on your monthly statement under the name "Longevity Plus".