Please print and complete this form and mail or FAX to: 1-620-227-8474
 
Item
Quantity
X Price
Total Price
BOSS 2000-3 ______
$460.00
________
MVP 700 ______ $460.00 ________
"EASY LOAD" Ring Loading System
Does not include tube or loading cone
______ $49.95 ________
Ultimate II Rings
Please circle size:                    X  I  II  III  IV
(X is smallest and IV is largest)
Minimum order of Two (2) Rings Required.
______
$15.00
________
Ultimate Rings
Please circle size:                    #0 #1  #2  #3
(#0 is smallest and #3 is largest)
Minimum order of Two (2) Rings Required.
______ $20.00 ________
Adapter Bushings
Please circle size:                    A   B   C
(A is largest and C is smallest)
______ $20.00 ________
Regular 2" x 8" Penile Tube
Please circle type:                Twist On      Slip On
______ $25.00 ________
Large 2 1/4" x 10" Penile Tube + Loading Cone + Bushing
Please circle type:                Twist On      Slip On
______ $75.00 ________
Loading Cone ______ $15.00 ________
BOSS 2000-2 Replacement Pumphead ______
$120.00
________
Rejoyn Replacement Pumphead ______ $75.00 ________
Water Soluble Jelly Lubricant ______ $4.50 ________
Zipper Carrying Case ______ $20.00 ________
BOSS System Instructional Videos ______ $10.00 ________
BOSS System User's Manual ______ $6.00 ________
Subtotal: ________
US Shipping & Handling:
$15 Standard Shipping (UPS)
$8 Standard Shipping (US Mail)
$25 Express Shipping (2-3 days)
$45 Rush Shipping (overnight)
________
International Shipping & Handling:
$28 Canada
$25 Mexico
$65 South America
$80 Europe
$72 Africa
$62 India
$50 Asia
________
Sales Tax for Kansas Residents: 7.3% ________
Total: ________
Minimum Order of $30

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Please print and complete this form and mail or FAX to: 1-620-227-8474
Mail to: Pos-T-Vac Inc
1701 N 14th Ave
Dodge City, KS 67801