Order Online

We offer four easy ways to order:

Telephone: In the USA 1.800.336.7022. International.
Order Online: Use our secure server by filling in the credit card and address information. Then press the SUBMIT FORM button below. We accept Discover, MasterCard and Visa.

Inglis Drink-Aide™
2600 Belmont Avenue
Philadelphia, PA 19131-2799

Note: you also may email your order to drinkaide@inglis.org

credit cards accepted Discover VISA Master Charge

Your purchase will appear as a charge to "INGLIS DRINK-AIDE" on your credit card statement.

Within the USA, we ship the Drink-Aide™ via USPS Priority Mail with a required signature confirmation of delivery. Call or email for prices and shipping/handling charges on Drink-Aide™ orders of 9 or more. For International orders, please read our International shipping policy. Please note that all international orders are shipped via FedEx.

Read our Limited Guarantee and Return Policy

Purchaser's Address:
(Note: For credit card purchases, the Name and Address fields should be the same as on your credit card billing statement)

(Note: Fields marked with a * are required)

Date:	*
Name:	*
Company Name:
Address:	*
City:	*
State:	*
Zip:	*
Country:	*
Daytime Phone:	*
E-mail Address:

Ship-to Address:
(If different from purchaser's address)

Name:
Company Name:
Address:
City:
State:
Zip:
Country:
Daytime Phone:
E-mail Address:

Items	Unit Cost	Quantity Ordered	Total $ Amount
Drink-Aide™. w/ 32" straw (standard)	$65.50
Drink-Aide™ w/ 40" straw	$71.50
Spare Straw for 32" flexible tube	$5.50
Spare Straw for 40" flexible tube For the cost of other spare parts, see our FAQ	$6.75
Drink-Aide™ Shipping/Handling 1 - $13 2 - $16 3 - $19 4 - $22 5 - $25 6 - $28 7 - $31 8 - $34 FAQ	Drink-Aide™ (USA only)

Within the USA, we ship the Drink-Aide™ via USPS Priority Mail with a signature confirmation of delivery. Call or email for prices and shipping/handling charges on Drink-Aide™ orders of 9 or more. For International orders, please read our International shipping policy.

To inquire about spare parts or bulk orders, contact us: 1.800.336.7022 (USA only).
drinkaide@inglis.org

Payment Method: *

Money Order payable to Inglis Drink-Aide™. Note: Your order will not be processed until we receive your money order. Please print this completed form and send it along with your payment to the address above.

I hereby authorize Inglis to charge my credit card as follows:

Card Type:
Exp. Date:
Card Number:
Validation Number:
Note:	Please proofread your card number entry to make sure you have entered the correct numbers. Please include the validation code number in the box above. On Visa, Master Charge and Discover cards, the validation code number is the last three-digits in the signature field on the BACK of the card. Your purchase will appear as a charge to "INGLIS DRINK-AIDE" on your credit card statement.

Comments:
[general comments or what other products would you like us to develop and why?]

Optional

Please tell us about yourself or the person for whom you are purchasing Drink-Aide™. Help us serve you better by answering the following questions.

What is your living situation?

Independent living		Assisted living		Long-term care
Other

How did you hear about Drink-Aide™?

Select

Other

What diagnosis/physical disability do you have?

Multiple Sclerosis		Cerebral Palsy
Spinal Cord Injury		Other

Please indicate your age:

Under 20

21-30

31-40

41-50

50+

If you have questions, please call 1.800.336.7022.

Thanks again for your order!