[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-203306-105":59,"doc-detail-203306-en":130},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":123,"head_meta":125,"extra_data":127,"updated_unix":129},105,"en","product-order-form-north-america-aconsdynamic-prosthetic-foot-component","Product Order Form - North America - Acons/Dynamic Prosthetic Foot Component","","North America product order form for prosthetic components, capturing customer identifiers, purchase order and date, and full billing and shipping details. 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(LEAVE BLANK IF SAME AS BILLING)  \nFACILITY/ATTN: FACILITY/ATTN:  \n\n| ADDRESS | ADDRESS |  |\n| --- | --- | --- |\n| CITY STATE/ZIP | CITY | STATE/ZIP |\n| PHONE FAX | PHONE | FAX |\n| CARRIER* ¨ UPS ¨ OTHER | DATE REQUIRED | TIME |\n| *ORDERS SHIP UPS GROUND ON THE FOLLOWING DAY UNLESS SPECIFIED. | EMAIL |  |\n\nPATIENT INFORMATION  \nPROSTHETIST NAME REQUISITIONER  \nPATIENT ID  \nREFERENCE  \nU.S. Shoe size chart  \n\n| cm | 21 | 22 | 23 | 24 | 25 | 26 | 27 | 28 |\n| --- | --- | --- | --- | --- | --- | --- | --- | --- |\n| Youth/Men | 2-2.5 | 3-4 | 4.5-5 | 5.5-7 | 7.5-8 | 8.5-9 | 9.5-10.5 | 11-11.5 |\n| Women | 4-4.5 | 5-5.5 | 6-6.5 | 7-8 | 8.5-9.5 | 10-10.5 | 11-11.5 | 12 |\n\nADJUSTABLE HEEL  \nPART  \nID SIDE  \nSHELL  \nCOLOR MOUNTING  \nBUTTON  \nPLACEMENT SIZE WIDTH  \nFIRMNESS CATEGORY  \n| L |  |  |  |\n| --- | --- | --- | --- |\n| R |  |  |  |\n\n\n| AC |\n| --- |\n| AC |\n\n\n| Caucasian | C |\n| --- | --- |\n| Brown | B |\n\n\n| Medial | M |\n| --- | --- |\n| Lateral | L |\n\n\n| Integrated Pyramid | IP |\n| --- | --- |\n| Dynamic Pylon + Receiver | DF |\n| Dynamic Pylon + Adapter | DM |\n| Dynamic Pylon + 4-hole | D4 |\n\n|  |  |\n| --- | --- |\n|  |  |\n\nDD  \n1-3  \n\n|  |  |\n| --- | --- |\n|  |  |\n\nNarrow  \nWide 23-26cm only  \nN  \nW  \nCollege Park suggests the  \n21-28cm  \nWide option for male patients.  \nWEIGHT LBS 0-120 121-140 141-160 161-180 181-220 221-250  \nSIZE CM 21-28 25-28  \nLOW IMPACT  \nMODERATE IMPACT  \n1  \n1  \n1  \n2  \n2  \n2  \n2  \n3  \n3  \n3  \n3  \n3  \n\n|  |  |  |  |  |  |  |\n| --- | --- | --- | --- | --- | --- | --- |\n|  |  |  |  |  |  |  |\n|  |  |  |  |  |  |  |\n\nAdditional Accessories:  \n¨ Shelltread Ask about Skinergy cosmetic covers!  \n27955 College Park Dr, Warren, MI 48088, USA  \n[EMAIL COMPLETED ORDER FORM TO:](EMAIL COMPLETED ORDER FORM TO: orders@college-park.com)[ orders@college-park.com](EMAIL COMPLETED ORDER FORM TO: orders@college-park.com)  \nTOLL FREE 800.728.7950 FAX 586.294.0067 ON THE WEB [college-park.com](college-park.com)  \n044 FRM FOF NA 241122  \nPRODUCT ORDER FORM  \nNORTH AMERICA | ACCENT  \nCUSTOMER \\# P.O.\\# DATE  \nPROSTHETIST INFORMATION  \nBILLING SHIPPING (LEAVE BLANK IF SAME AS BILLING)  \nFACILITY/ATTN: FACILITY/ATTN:  \n\n| ADDRESS | ADDRESS |  |\n| --- | --- | --- |\n| CITY STATE/ZIP | CITY | STATE/ZIP |\n| PHONE FAX | PHONE | FAX |\n| CARRIER* ¨ UPS ¨ OTHER | DATE REQUIRED | TIME |\n| *ORDERS SHIP UPS GROUND ON THE FOLLOWING DAY UNLESS SPECIFIED. | EMAIL |  |\n\nPATIENT INFORMATION  \nPROSTHETIST NAME REQUISITIONER  \nPATIENT ID  \nREFERENCE  \nU.S. Shoe size chart  \n\n| cm | 21 | 22 | 23 | 24 | 25 | 26 | 27 | 28 | 29 | 30 |\n| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |\n| Youth/Men | 2-2.5 | 3-4 | 4.5-5 | 5.5-7 | 7.5-8 | 8.5-9 | 9.5-10.5 | 11-11.5 | 12-13 | 14 |\n| Women | 4-4.5 | 5-5.5 | 6-6.5 | 7-8 | 8.5-9.5 | 10-10.5 | 11-11.5 | 12 |  |  |\n\nPART  \nID SIDE  \nSHELL  \nCOLOR MOUNTING SIZE  \nFIRMNESS CATEGORY  \nK3/4  \nAV  L   EN    D     \nAV   R   EN     D     \nCaucasian  C  21-30cm 1-5  \n Tan  T   \n Brown  B   \n Jet Black  J   \nWEIGHT LBS  \nSIZE CM  \nMODERATE-HIGH IMPACT SIZE CM  \n0-140  \n21-25 1  \n26-30  \n141-180  \n2  \n181-220  \n3  \n221-275  \n4  \n276-330  \nN/A  \nMODERATE-HIGH IMPACT 1 2 3 4 5  \n\n|  |  |  |  |  |  |\n| --- | --- | --- | --- | --- | --- |\n|  |  |  |  |  |  |\n|  |  |  |  |  |  |\n|  |  |  |  |  |  |\n\nAdditional Accessories:  \n£ Shelltread  \n27955 College Park Dr, Warren, MI 48088, USA  \n[EMAIL COMPLETED ORDER FORM TO:](EMAIL COMPLETED ORDER FORM TO: orders@college-park.com)[ orders@college-park.com](EMAIL COMPLETED ORDER FORM TO: orders@college-park.com)  \nTOLL FREE 800.728.7950 FAX 586.294.0067 ON THE WEB [college-park.com](college-park.com)  \n044 FRM FOF NA 241122  \nPRODUCT ORDER FORM  \nNORTH AMERICA | BREEZE  \nCUSTOMER \\# P.O.\\# DATE  \nPROSTHETIST INFORMATION  \nBILLING SHIPPING (LEAVE BLANK IF SAME AS BILLING)  \nFACILITY/ATTN: FACILITY/ATTN:  \n\n| ADDRESS | ADDRESS |  |\n| --- | --- | --- |\n| CIT","cbCaiaViTIULbQ0f","https://ap.wps.com/l/cbCaiaViTIULbQ0f","pdf",3292425,23,"English","# Product Order Form\n## Customer and Order Details\n## Prosthetist and Patient Information\n## Sizing and Component Specifications\n## Shipping, Carrier, and Delivery Notes\n## Additional Accessories and Contact Information","[{\"question\":\"What information is required to place an order on this form?\",\"answer\":\"The form collects customer number, P.O. number, date, and prosthetist information, along with billing and shipping facility/address fields.\"},{\"question\":\"How does the form link shoe size to prosthetic sizing?\",\"answer\":\"It provides a U.S. shoe size chart in centimeters, listing corresponding youth/men and women size ranges across multiple cm values.\"},{\"question\":\"Which prosthetic component selections can be specified?\",\"answer\":\"Selections include part ID, side, shell, color, mounting, size, and firmness category, with options such as adjustable heel and impact level categories.\"}]","Product Order Form - North America - Acons/Dynamic Prosthetic Foot Component | PDF",58]