Dan from Tokyo, Japan Orders X1 Turf Toe Blade for Rugby

New Order (#3754)

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www.indianabrace.com	9:16 AM (55 minutes ago)

Order Confirmation

Thank you for your order, Dan Pxxxxx. Your order number is: 3754 Date of order: 5/6/2013 9:16 AM Shipping Method: USPS Priority Mail International Payment Method: Credit card payment
Ship To Dan Pxxxxx Setagaya-Ku xxxxx 2-19-XX Gureisukoto Taxxxxxx A-1 Tokyo, Kanto 157-0068 Japan Phone:0801XXX28XX	Phone:08013022890
Additional Information Diagnosis: Turf Toe
Product Information
Product Name Part No. Quantity Item Price Total Price "STOP THE OUCH!" - CLYDE'S REMARKABLE X1 BLADES FOR TURF TOE & HALLUX RIGIDUS Foot: Right Model: "Pro" Heavy Activity (football,basketball, soccer) Size / CM: Women's 10 Men's 9 Diagnosis:: Turf Toe How Will You Be Using Your X1 Blade?: rugby boots I acknowledge and agree to the terms and conditions of Indiana Brace's Sales and Refund Policy.: Yes Comment About Your Injury?: TL-501-27-P-R 1 $109.95 $109.95 Subtotal: $109.95 Shipping: $42.50 Tax: $0.00 Order Total: $152.45