Global Utilities

Facilities List
Add or Change Details

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Use this form to request additions or changes to our list
 
* = Required Entry
Date:*
Requested by:*
Email Address:*
Type of request:
Add a new Facility to our list
Change details for an existing listing
Facility Details
Name of Facility:
Number & Street:
Town:
Post Code:
State:
Country:
 Alternate Postal Address:
Post Office Box:
P.O. Box Code:
Town:
State:
Country:
Communication Data:
Telephone:
Facsimile:
Contact Name:
Website:
About your Facility  

Services Offered:

 

Prosthetics
Orthotics
Both
Are you an accredited artificial limb scheme supplier? YES
NO

Comments:

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Last modified: January 8, 2003