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Catalogs
College Park
PRODUCT ORDER FORM

PRODUCT ORDER FORM

Product catalog summary

Product Order Form Overview

This document serves as a comprehensive order form for prosthetic components from College Park Industries, designed for use by prosthetists. It includes sections for prosthetist and patient information, detailed product specifications, and ordering instructions.

Prosthetist Information

This section requires the prosthetist to provide facility details, including billing and shipping addresses, contact information, customer number, purchase order number, and the order date. Preferred shipping carriers can also be specified.

Patient Information

Details such as the prosthetist's name, requisitioner, and patient ID or name are required. Completed forms should be emailed to [email protected].

Product Specifications

The form includes specifications for various prosthetic products, categorized by product lines like Accent, Breeze, Celsus, and others. Options include part ID, side (left or right), shell color, mounting type, size, firmness category, and additional accessories.

Size and Impact Charts

Size charts correlate foot length in centimeters to U.S. shoe sizes for youth/men and women. Weight and impact level charts guide the selection of firmness categories based on the patient's weight and activity level.

Additional Accessories and Customizations

Options for accessories such as Shelltread, cosmetic covers, and various adapters are available. The Soleus line offers custom engravings at no extra charge.

Contact Information

For inquiries or orders, contact details include a toll-free number, fax number, and the company's website.

Patient and Prosthetist Information

Fields for customer number, purchase order number, and date.
Sections for patient ID/name and prosthetist name.
Contact information for order submission via email, phone, or fax.

Product Specifications

Options for right or left side prosthetics.
Shell color options: Caucasian, Tan, Brown, Jet Black.
Mounting size and width options, with recommendations for wide options for male patients.
Firmness categories and additional accessories like Shelltread, Exo Block, and Exo Alignment Tool.

Sizing and Impact Categories

U.S. shoe size chart for youth/men and women.
Weight categories and corresponding size recommendations for low, moderate, and high impact activities.
Specific size recommendations for different impact levels, focusing on sizes 21-30 cm.

Shipping and Billing Information

Fields for billing and shipping addresses, with an option to leave shipping blank if it matches billing.
Carrier options, primarily UPS, with notes on shipping timelines.

Catalog excerpts

PRODUCT ORDER FORM NORTH AMERICA | ACCENT CUSTOMER # PROSTHETIST INFORMATION BILLING SHIPPING (LEAVE BLANK IF SAME AS BILLING) DATE REQUIRED *ORDERS SHIP UPS GROUND ON THE FOLLOWING DAY UNLESS SPECIFIED. PATIENT INFORMATION PROSTHETIST NAME PATIENT ID / NAME REFERENCE U.S. Shoe size chart cm ADJUSTABLE HEEL PART ID SHELL COLOR Integrated Pyramid BUTTON PLACEMENT Dynamic Pylon + Receiver DF Additional Accessories: ¨ Shelltread Ask about Skinergy cosmetic covers! Dynamic Pylon + Adapter DM Dynamic Pylon + 4-hole FIRMNESS CATEGORY College Park suggests the Wide option for male patients. LOW IMPACT MODERATE IMPACT EMAIL COMPLETED ORDER FORM TO: [email protected] 27955 College Park Dr, Warren, MI 48088, USA TOLL FREE 800.728.7950 FAX 586.294.0067 ON THE WEB college-park.com

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PRODUCT ORDER FORM NORTH AMERICA | BREEZE CUSTOMER # PROSTHETIST INFORMATION BILLING SHIPPING (LEAVE BLANK IF SAME AS BILLING) DATE REQUIRED *ORDERS SHIP UPS GROUND ON THE FOLLOWING DAY UNLESS SPECIFIED. PATIENT INFORMATION PROSTHETIST NAME PATIENT ID / NAME REFERENCE U.S. Shoe size chart cm SHELL COLOR Additional Accessories: ¨ Shelltread FIRMNESS CATEGORY EMAIL COMPLETED ORDER FORM TO: [email protected] 27955 College Park Dr, Warren, MI 48088, USA TOLL FREE 800.728.7950 FAX 586.294.0067 ON THE WEB college-park.com

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PRODUCT ORDER FORM NORTH AMERICA | CELSUS CUSTOMER # PROSTHETIST INFORMATION BILLING SHIPPING (LEAVE BLANK IF SAME AS BILLING) DATE REQUIRED *ORDERS SHIP UPS GROUND ON THE FOLLOWING DAY UNLESS SPECIFIED. PATIENT INFORMATION PROSTHETIST NAME PATIENT ID / NAME REFERENCE U.S. Shoe size chart cm SHELL COLOR FIRMNESS CATEGORY Additional Accessories: ¨ Shelltread EMAIL COMPLETED ORDER FORM TO: [email protected] 27955 College Park Dr, Warren, MI 48088, USA TOLL FREE 800.728.7950 FAX 586.294.0067 ON THE WEB college-park.com

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PRODUCT ORDER FORM PROSTHETIST INFORMATION BILLING SHIPPING (LEAVE BLANK IF SAME AS BILLING) DATE REQUIRED *ORDERS SHIP UPS GROUND ON THE FOLLOWING DAY UNLESS SPECIFIED. PATIENT INFORMATION PROSTHETIST NAME PATIENT ID / NAME REFERENCE U.S. Shoe size chart cm SHELL COLOR SIZE CM HIGH IMPACT LOW-MODERATE IMPACT Additional Accessories: FIRMNESS CATEGORY EMAIL COMPLETED ORDER FORM TO: [email protected] 27955 College Park Dr, Warren, MI 48088, USA TOLL FREE 800.728.7950 FAX 586.294.0067 ON THE WEB college-park.com

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PRODUCT ORDER FORM NORTH AMERICA | ODYSSEY K2 CUSTOMER # PROSTHETIST INFORMATION BILLING SHIPPING (LEAVE BLANK IF SAME AS BILLING) DATE REQUIRED *ORDERS SHIP UPS GROUND ON THE FOLLOWING DAY UNLESS SPECIFIED. PATIENT INFORMATION PROSTHETIST NAME PATIENT ID / NAME REFERENCE U.S. Shoe size chart cm SHELL COLOR Additional Accessories: ¨ Shelltread FIRMNESS CATEGORY EMAIL COMPLETED ORDER FORM TO: [email protected] 27955 College Park Dr, Warren, MI 48088, USA TOLL FREE 800.728.7950 FAX 586.294.0067 ON THE WEB college-park.com

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PRODUCT ORDER FORM NORTH AMERICA | ODYSSEY K3 CUSTOMER # PROSTHETIST INFORMATION BILLING SHIPPING (LEAVE BLANK IF SAME AS BILLING) DATE REQUIRED *ORDERS SHIP UPS GROUND ON THE FOLLOWING DAY UNLESS SPECIFIED. PATIENT INFORMATION PROSTHETIST NAME PATIENT ID / NAME REFERENCE U.S. Shoe size chart cm SHELL COLOR Additional Accessories: ¨ Shelltread FIRMNESS CATEGORY LOW IMPACT MODERATE IMPACT EMAIL COMPLETED ORDER FORM TO: [email protected] 27955 College Park Dr, Warren, MI 48088, USA TOLL FREE 800.728.7950 FAX 586.294.0067 ON THE WEB college-park.com

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PRODUCT ORDER FORM NORTH AMERICA | SIDEKICKS CUSTOMER # PROSTHETIST INFORMATION BILLING SHIPPING (LEAVE BLANK IF SAME AS BILLING) DATE REQUIRED *ORDERS SHIP UPS GROUND ON THE FOLLOWING DAY UNLESS SPECIFIED. PATIENT INFORMATION PROSTHETIST NAME PATIENT ID / NAME REFERENCE FIRMNESS CATEGORY EMAIL COMPLETED ORDER FORM TO: [email protected] 27955 College Park Dr, Warren, MI 48088, USA TOLL FREE 800.728.7950 FAX 586.294.0067 ON THE WEB college-park.com

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PRODUCT ORDER FORM NORTH AMERICA | SOLEUS CUSTOMER # PROSTHETIST INFORMATION BILLING SHIPPING (LEAVE BLANK IF SAME AS BILLING) DATE REQUIRED *ORDERS SHIP UPS GROUND ON THE FOLLOWING DAY UNLESS SPECIFIED. PATIENT INFORMATION PROSTHETIST NAME PATIENT ID / NAME REFERENCE U.S. Shoe size chart cm Perfect Pink Midnight Black HOUSING COLOR College Park suggests the Wide option for male patients. FIRMNESS CATEGORY Additional Accessories: SHELL COLOR Shelltread Rotatable Adapter Rotatable Receiver Standard Adapter - Titanium Standard Receiver - Titanium Standard Adapter - Stainless Steel Standard Receiver...

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PRODUCT ORDER FORM NORTH AMERICA | SOLEUS CUSTOMER # PROSTHETIST INFORMATION BILLING SHIPPING (LEAVE BLANK IF SAME AS BILLING) DATE REQUIRED *ORDERS SHIP UPS GROUND ON THE FOLLOWING DAY UNLESS SPECIFIED. PATIENT INFORMATION PROSTHETIST NAME SOLEUS FIRMNESS CATEGORIES WEIGHT LBS CUSTOM ENGRAVINGS Check one box under design. Allow two extra days for processing. No additonal charge. Soleus only. NO ENGRAVING SUPER STARS LIGHTNING ON YOUR FEET EMAIL COMPLETED ORDER FORM TO: [email protected] 27955 College Park Dr, Warren, MI 48088, USA TOLL FREE 800.728.7950 FAX 586.294.0067 ON THE WEB college-park.com...

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PRODUCT ORDER FORM NORTH AMERICA | TEMPO CUSTOMER # PROSTHETIST INFORMATION BILLING SHIPPING (LEAVE BLANK IF SAME AS BILLING) DATE REQUIRED *ORDERS SHIP UPS GROUND ON THE FOLLOWING DAY UNLESS SPECIFIED. PATIENT INFORMATION PROSTHETIST NAME PATIENT ID / NAME REFERENCE U.S. Shoe size chart cm FIRMNESS CATEGORY Additional Accessories: ¨ Shelltread SHELL COLOR EMAIL COMPLETED ORDER FORM TO: [email protected] 27955 College Park Dr, Warren, MI 48088, USA TOLL FREE 800.728.7950 FAX 586.294.0067 ON THE WEB college-park.com

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PRODUCT ORDER FORM NORTH AMERICA | TRIBUTE CUSTOMER # PROSTHETIST INFORMATION BILLING SHIPPING (LEAVE BLANK IF SAME AS BILLING) DATE REQUIRED *ORDERS SHIP UPS GROUND ON THE FOLLOWING DAY UNLESS SPECIFIED. PATIENT INFORMATION PROSTHETIST NAME PATIENT ID / NAME REFERENCE U.S. Shoe size chart cm SHELL COLOR Regular Toe Leave Blank FIRMNESS CATEGORY Additional Accessories: ¨ Shelltread *Wide not available in Sandal Toe. Leave field blank if ordering Sandal Toe. College Park suggests the Wide option for male patients. LOW IMPACT MODERATE IMPACT EMAIL COMPLETED ORDER FORM TO: [email protected]...

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*Prices are pre-tax. They exclude delivery charges and customs duties and do not include additional charges for installation or activation options. Prices are indicative only and may vary by country, with changes to the cost of raw materials and exchange rates.

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