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                   COMO AI USO LOS TRANSATLANTICOS de FLUSHABLE  Tips  Trial Sample  


 
Send  a STAMPED, self-addressed standard postage envelope to C&M Ostomy Supplies, Inc. ,
  P.O. Box 291554, Davie, Florida 33329-1554 with a copy of the form below for a FREE SAMPLE.   

First Name:

*

Last Name:

*

Address:

*

City:

*

State:

*

Zip:

*

Phone:

*

Country:

Fax:

E-Mail:

*

Comments:

     Product Name & Number - Please supply in order to receive a TRIAL sample:*
        

     Stoma Size - Please supply in order to receive a TRIAL sample:*
    

      2.  Choose one or more of the following and make sure you check your opening size below: 

 I have a colostomy       1 3/4" Opening (45mm wafer size)
 I have an ileostomy      2 1/4"  To 2 3/4" Opening (57mm or 70mm wafer size)
 I am presently using a two-piece system

      3.  Should you have any comments or questions please fill in the appropriate information
            above with  your comments or questions and click the Submit button.  Click on Cancel
            to change your mind.  Remember, if you wish you receive a sample you must send us
            a stamped, self addressed envelope and a copy of this form.
  See above for address.

 


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