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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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