Bls Non Secure Ts Order Form

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Revised 3/2007
Date:
____________
County:
________________
Customer Name:
_________________________________________________________
Billing Address:
_________________________________________________________
_________________________________________________________
Shipping Name:
_________________________________________________________
Shipping Address:
_________________________________________________________
_________________________________________________________
BOOKS
Each
Qty
Cost
*BLS Healthcare Provider
$15.00
*BLS Instructor Manual
$95.00
*Heartsaver Instructor Manual
$60.00
*HS CPR-Adult/Child-AED/Infant
$15.00
Please Make Payable to:
*HS Pediatric FA Adult/Child-AED/Infant CPR
$18.00
Healthy U Educators
*HS FA w/Adult & Child-AED/Infant CPR
$18.00
Please attach order form with payment:
CARDS
Each
Qty
Cost
Healthy U Educators
*BLS Healthcare Provider
$4.00
Attn: TC Coordinator
*HS AED
$4.00
1818 Brigham Young
*HS CPR
$4.00
Casper, WY 82604
*HS Pediatric FA Adult/Child-AED/Infant CPR
$4.00
*HS FA/ Adult & Child AED/Infant CPR
$4.00
Cards ONLY => => => $2.00 per 24 pkg
*Instructor Card
BLS #____
HS #____
$6.00
FED EX
$25.00
Replacement Card
$10.00
$0-$10.00
$ 5.00
DVDS
Each
Qty
Cost
$11.00 - $16.00
$8.00
*BLS HCP DVD Set
$95.00
$17.00 - $22.00
$10.00
*BLS HCP Instructor DVD Package
$100.00
$23.00 - $30.00
$15.00
*HS AED DVD Set
$95.00
$31.00 +
$20.00
*HS First Aid DVD Set
$100.00
*HS Pediatric First Aid DVD Set
$100.00
Subtotal
TCF Instructor Materials
Each
Qty
Cost
Shipping / Handling Total
*BLS TCF Guide CD
$15.00
Tax Exempt
Yes
No
*BLS TCF Guide Binder
$25.00
Tax Rate
%
*BLS TCF Instructor Rollout DVD Set
$15.00
Total Due
*BLS/HS Instructor Faculty Guide Binder
$10.00
Payment Method
*CIC DVD, Facilitator guide & student book
$75.00
Cash
Check
Money Order
EFT
E-Check
OTHER
Each
Qty
Cost
We DO NOT ACCEPT CREDIT CARDS
CPR Anytime Kit (Adult & Child only)
$55.00
TC OFFICE USE ONLY
CPR Anytime AED Kit (Adult & Child Only)
$65.00
Balance Total
CPR Anytime Infant Kit
$45.00
Credit Total
CPR Key Chain Mask
$10.00
Payment #
* New 2005 Curriculum Prices
Subtotal
Invoice #

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