Apron Order Form MedTach Inc. 4145 North Service Road, Suite 200, Burlington, Ontario L7L 6A3 Phone 905-289-4985 Fax 289-288-5201 order@medtach.com (Please send orders by email or Fax)

Apron/Item

Apron Style: Choose a style

Outside Fabric: Choose fabric

Inside Fabric: Choose fabric

Binding Color: Choose color

QTY: Click here to enter text.	Misc: Click here to enter text.

Male Size Choose size	Female Size Choose size	Inner Material Protection	Front Protection Lead Equiv.	Back Protection Lead Equiv.

Custom Apron Sizes:

Neck: Click here to enter text.	Chest: Click here to enter text.	Waist: Click here to enter text.	Hip: Click here to enter text.
Vest Length: Click here to enter text.	Skirt Length: Click here to enter text.	1PC Length: Click here to enter text.	Width Adj.: Click here to enter text.
Length Adj.: Click here to enter text.	Height: Click here to enter text.	Weight: Click here to enter text.

Thyroid

Outside Fabric: Choose fabric

Inside Fabric: Choose fabric

Binding: Choose color

Thyroid Style	Size	Attachment to Apron	Closure at Back of Neck
Choose style	Choose size	Choose TC attachment	Choose TC back closure

Embroidery

Embroidery: Two lines on pocket is one charge; anything else is an additional cost. 22 Spaces Max Per Line for BLOCK / 20 Spaces Max Per Line for SCRIPT. Please print CLEARLY and EXACTLY the way it is to be embroidered, including punctuation and spaces.

BLOCK	☐	SCRIPT	☐	Thread Color: Choose color	All Caps	☐	Upper/Lower	☐

Location:	1st line: Click here to enter text.

Choose an item. 2nd line: Click here to enter text.

Embroidery on Thyroid: Click here to enter text.

Embroidery on Inside: Click here to enter text. (specify location) Click here to enter text.

Embroidery on Outside: Click here to enter text. (specify location) Click here to enter text.

Notes: Click here to enter text.

Hospital/Facility: Click here to enter text. Name: Click here to enter text. Phone: Click here to enter text. Email:Click here to enter text.	Address: Click here to enter text. Address: Click here to enter text. City: Click here to enter text. Province: Select Prov. PC: Click here to enter text.