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Phone: 760.944.1048 Fax: 760-944-2959 |
Please
Fill in Order Form Completely. Type or Print Clearly all Information! Manikin Fax/Mail Order Form ORDER NUMBER (If any): |
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Billing Name: |
Ship To Address (If Different): |
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Credit Card Billing Address: |
Company Name: |
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Attention: |
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Billing Phone: |
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Email: |
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Fax: |
Include Suites, Departments, Room Numbers, Etc. |
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ORDER Date |
requisitioner |
Ship via |
f.o.b. point |
terms |
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FedEx Ground |
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Pre Pay |
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qty |
SKU / ITEM# |
description |
unit price |
total |
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CREDIT
CARD PAYMENT (MC/VISA/AMEX
ONLY) |
SUBTOTAL |
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Daytime
Tel: |
SALES TAX ( |
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Name on CC: |
SHIPPING & HANDLING (SEE
CHART) |
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Expiration
Date: |
OTHER |
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CC #:
Security Code #: |
TOTAL |
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(I have read, and agree
with the online Shipping & Return policies) Authorized by Sign Here X__________________________ Date_______ Shipping (Based on product total) 8-14 Business day delivery/48 continental US States |
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Send all payments by check to: Express Companies, Inc. dba
American EHS / American CPR 449 Santa Fe Drive, Suite 127, Encinitas, CA 92024 760.944.1048
E-MAIL: cpr@americancpr.com If you require Express Shipping beyond our
normal 8-14 business days, please indicate this on your order form and leave
the shipping & handling blank…we will determine express shipping rate to
your address, and fax back to you for final approval. $100 order minimum for
Express. (Please follow the above process for HI, AK,
PR, & Canadian Shipping Quotes) |
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$0.01 -
9.99 |
$ 6.50 |
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$10.00 -
49.99 |
$ 7.75 |
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$50.00 -
99.99 |
$10.75 |
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$100.00 -
199.99 |
$15.75 |
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$200.00 -
399.00 |
$26.50 |
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$400.00 - 699.00 |
$36.50 |
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$700.00 -
1000.00 |
$46.50 |
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$1000.00
- $1800.00 |
$56.50 |
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$1801.00
+ |
CALL FOR SHIPPING
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IF YOU DO NOT PROVIDE AN EMAIL ADDRESS,
YOU WILL NOT RECEIVE A RECEIPT!
OUR RECEIPTS ARE GENERATED AUTOMATICALLY AND
EMAILED UPON PROCESSING.
(Manikins
& Manikin Supplies on next page!)
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Order Date |
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Order Form
Prices effective 04/01/07 |
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Order
#
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Item# |
Description |
Price Ea. |
Qty. |
Total |
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Home Products |
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Home
Learning System (includes 1 Adult/Child |
$79.95 |
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HLSVID |
CPR Prompt Adult, Child
& Infant Home Learning Video |
$19.95 |
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SPANVID |
SPANISH VID ~ CPR Prompt
Adult, Child & Infant Home Learning Video |
$19.95 |
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Voice Prompting Devices |
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CPR200 |
CPR Prompt Rescue & Practice
Aid *
New Keychain size |
$32.95 |
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CPR300 |
CPR Prompt Rescue & Practice
Aid ~12 different CPR
procedures for Adults, Children & Infants
~Follows NEW ECC GUIDELINES |
$40.00 |
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Professional Training Products |
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Adult/Child Training Manikin W/10
face shield / lung bags |
$66.00 |
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Infant Training Manikin w/ 10
face shield / lung bags |
$43.00 |
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