Request for Information Form

Please send me the following

• Information Packet (contains all product catalogs, order forms, and prepaid mailing labels)
• Custom Orthotic Catalog
• Ped Pillows™ Pre-Fabricated Orthotics Catalog
• The Richie Brace® Catalog
• Marathon Leather Gauntlet Catalog
• Medicare Compliant Diabetic 3-Pair Custom Inserts & Shoe Program Catalog
• Marathon Night Splints

Order Forms

• Custom Orthotic Prescription Form
• Ped Pillows™ Order Forms
• The Richie Brace® Order Forms
• Shoe Order Form
• Shoe Return Form
• pw minor shoe return form
• Marathon Gauntlet Order Form
• Custom Orthotics Info. Brochure (for in office distribution to patients)
• UPS labels (for current accounts)
• USPS labels

Please enter the following information

* = Required

• Name *
• Organization Name *
• Address *
• City *
• State *
• Zip Code *
• Phone *
• Fax
• Email *
• Account Number
• How did you hear about Marathon Orthotics, Inc.? Search Engine Direct Mail Met At Conference Referral Other
• Comments
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If you are a patient seeking custom orthotics, please note that we do not distribute our products to the general public. For more information please see a medical professional.

Thank you for your interest in Marathon Orthotics, Inc.