ChipSleeve
P: 866.931.0876
F: 866.931.0052
[email protected]
TM
ORDER FORM
PO#:
- ARM
Date:
Company:
Phone:
Contact Name:
Patient Name:
Sex:
Age:
Ht:
Wt:
Bill-To Name & Address:
Ship-To Name & Address:
PRODUCT INFORMATION
ARM:
Left
OVERSLEEVE (included):
Right
SIZE:
Black
Pink
Leopard
LENGTH:
Navy
Tie-Dye
Purple Paisley
Note: If no color is specified, a black OverSleeve™
will be included.
ITEM #:
SIZING CHART & ITEM NUMBERS
CHIPSLEEVE - ARM
Circumference at
AXILLA
C
B1
B
A
Circumference at
Circumference at
ELBOW
RIGHT
LENGTH
LEFT
MID BICEP
SHORT:
38 - 43
REGULAR:
43 - 48
LONG:
48 - 53
SHORT
SMALL
MEDIUM
LARGE
22 - 30
26 - 34
20 - 27
14 - 17
23 - 32
X-LARGE XX-LARGE
39 - 49
44 - 54
35 - 44
39 - 49
24 - 31
30 - 39
28 - 35
32 - 39
36 - 43
15 - 18
16 - 19
18 - 20
19 - 22
28 - 37
33 - 43
2631 - AS - L 2632 - AS - L 2633 - AS - L 2634 - AS - L 2635 - AS - L
REGULAR 2631 - AR - L 2632 - AR - L 2633 - AR - L 2634 - AR - L 2635 - AR - L
LONG
2631 - AL - L 2632 - AL - L 2633 - AL - L 2634 - AL - L 2635 - AL - L
SHORT 2631 - AS - R 2632 - AS - R 2633 - AS - R 2634 - AS - R 2635 - AS - R
REGULAR 2631 - AR - R 2632 - AR - R 2633 - AR - R 2634 - AR - R 2635 - AR - R
LONG
2631 - AL - R 2632 - AL - R 2633 - AL - R 2634 - AL - R 2635 - AL - R
Circumference at
WRIST
4