Roseburg, OR - Hoosier Face Mask Combo - broken nose with left orbit fracture

Order Confirmation

Thank you for your order, Chris Mxxx. Your order number is: 3682 Date of order: 4/15/2013 11:00 PM Shipping Method: FedEx Standard Overnight® Payment Method: Credit card payment
Ship To Chris Mxxx Roseburg, OR 97471 United States Phone:541-XXX-XXXX
Additional Information Diagnosis: Broken Nose with Orbit Fracture Left Side
Product Information
Product Name Part No. Quantity Item Price Total Price CLYDE'S HOOSIER MASKS - NO VISION OBSTRUCTION - EASY TO USE - WORLDWIDE SHIPPING Select A Model: Hoosier - Combination Nose & Facial Fx's What is the injury?: Broken Nose with Orbit Fracture Left Side Measurement A: Inside ear to ear across tip of nose.: 11" to 11 1/4" Measurement B: Top of forehead to tip of nose.: 4 1/2" Height?: 6'-0" Weight?: 165 LBS Sex?: Male Sport?: Baseball / Basketball I ackknowledge and agree to the terms and conditions of Indiana Brace's Sales and Refund Policy.: Yes L2999 1 $299.00 $299.00 Subtotal: $299.00 Shipping: $61.24 Tax: $0.00 Order Total: $360.24