Rainbow Latex-Free Exercise Band Free Sample Request

Name *

Title *

Company Name *

Email *

Phone *

North Coast Account #

What Latex Free resistance band do you currently purchase? *

BodySport®CanDoRainbow™REP BandSup-R Band™Theraband®

Do you generally purchase 50 yd rolls, precut bands, or both? *

50 yd.PrecutBoth

Do you sell or give bands away to patients for their home exercise programs? *

Give awaySellNeither

What attributes are you looking for in a Latex-Free Resistance Band? *

Competitive PriceEasy GripFunctional colorsOdor FreePowder FreeResistance feel similar to latex bands

If you find the Rainbow™ Latex Free Exercise Band to be superior in quality and price, as compared to what you are currently using, will you switch to Rainbow™ Latex Free Exercise Band? *

YesNo

What resistance level of Rainbow™ Latex Free Exercise Band would you prefer to receive? *

Level 1 - LightLevel 2 - MediumLevel 3 - HeavyLevel 4 - Extra HeavyLevel 5 - Super Heavy

Mailing Address

Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry

Rainbow Latex-Free Exercise Band Free Sample Request

Rainbow Latex-Free Exercise Band Free Sample Form

Verification

Hand Therapy

Physical Therapy

Occupational Therapy

Closeout Items