JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Order Form
Place an order for Wheely-X here.
We will get back to you with an email, so
please double check your email
.
Find us at
info@kang-sters.com
if you have any questions.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Your Full Name
*
Your answer
Your Email Address
*
We are going to send an invoice from Paypal through this email address.
Please write your email having Paypal account.
Your answer
Product
*
Wheely-X (Smart Wheelchair Treadmill)
Wheelster-mini (Wheelchair Wheel Cleaner)
Required
Your Phone Number
*
Your answer
Your Shipping Address
*
Please write your specific address including street, apt, city, state, country, and ZIP code
Your answer
Quantity
*
1
2
3
4
5
Purchase Use
*
Please notify your purchase type.
Customer
B2B Facility (Fitness Gym, Hospitals, Rehab etc)
Distributor / Seller
Others (R&D etc)
Required
Any comments or questions?
Your answer
Submit
Page 1 of 1
Clear form
Never submit passwords through Google Forms.
This form was created inside of 캥스터즈 주식회사.
Report Abuse
Forms
