Urinary Care Supply List
AZ Spina Bifida Assn
1001 East Fairmount Avenue
Phoenix, AZ 85014

Attn: Arlene Plouff

FAX: 602-274-7632

Print out form and fill out, then email or fax to the office (charge orders)... or mail form with check to above address

Please call 602-274-3323 for shipping costs- as prices vary, or send an email to mailto:office@azspinabifida.org
There will be an $11.00 shipping charge added to each order for briefs and/or pads up to a total of ten (10) cases. Call or email for shipping prices for catheters.
Products are not to be resold
Prices subject to change without notice
You must be a member of the ASBA to purchase(annual dues are $10)
However, you do not have to have SB to become a member

* The use of latex (NRL) is not recommended by the ASBA. For more information see our latex allergy information page.

click above to join

Please bill my:	place "X"
Visa
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In the amount of $
Card number
Expiration Date(mm/yyyy)
Name on card
Personal Check Enclosed
Name to be shipped
Address
City
State
Zip
Phone Number
Email Address
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