PRINTABLE ORDER FORM

Call (419) 234-2740 with questions.

NOTE: e-mail 'setz@rcscompany.com' for Ostomy Support Group or Distributor Pricing for all products listed!
$4.99 shipping applies to all domestic orders, for orders outside the U.S. please contact us regarding shipping.

Qty. Item Price Per Item TOTAL
STOMA CUP
FREE with purchase of any size"Handi-Ring".
(For Cup only purchases, the following prices shown apply.) 		1 @ $15.00
2 @ $12.50 ea.
3 @ $10.00 ea.		 $

"HANDI-RING" #100
Must be used with Ostomy Belt and 1-1/2" pouch.
For stomas 1/2" to 1" diameter or irregular shape.

 1 @ $33.00
2 @ $28.00 ea.
3 @ $25.00 ea.		 $

"HANDI-RING" #125
Must be used with Ostomy Belt and 1-3/4" pouch.
For stomas up to 1-1/4" diameter or irregular shape.

 1 @ $38.00
2 @ $33.00 ea.
3 @ $30.00 ea.		 $

"HANDI-RING" #175
Must be used with Ostomy Belt and 2-1/4" pouch.
 For stomas up to 1-3/4" diameter or irregular shape.

 1 @ $43.00
2 @ $38.00 ea.
3 @ $35.00 ea. 		$

Please note: as all items listed are considered a personal medical product, we are unable to accept returns for replacement of another size.
Further: RCS Company is not a Medicare Provider and therefore does not bill Medicare. If you are a Medicare recipient you must assume complete financial responsibility for your RCS purchases.

Grand Total $
Please send my order to:
NAME:
EMAIL:
ADDRESS:
CITY:
STATE:
ZIP CODE:

NOTE: You may complete, print, and mail the order form with check or money order to: RCS Company,

P.O. Box 226, Bluffton, Ohio 45817-0226.

Thank you for ordering your RCS Co. products. Your order will be sent immediately.

 

If required, further information may be obtained by contacting the RCSCOMPANY via E-mail or U.S mail:
 

E-mail: setz@rcscompany.com
RCS Company
P.O. Box 226
Bluffton, Ohio 45817-0226

 

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