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We
accept Visa, MasterCard, and American Express,
Checks and Purchase Orders. Please Print this out and fax to
949-644-3259 or mail to
Newport Beach Fire Department
P.O. Box 1434
Newport Beach, CA 92659-1434
To Process your order on-line click here! |
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Card No. |
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Name Issued To: |
Date of Order: |
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Name of Company: |
Check Enclosed: $ |
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Expiration Date:
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Or using Purchase Order #: |
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Amount Authorized: |
$ |
Email: |
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(Include 7.75% Sales Tax if In California) |
Provide email for UPS
shipping status and tracking. |
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Authorized Signature: X
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(Please Sign as Printed on Card)
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BILL TO
Name: |
SHIP TO
Name: |
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Attention: |
Attention: |
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Address: |
Address: |
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City, St, Zip: |
City, St, Zip: |
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Phone:
Fax: |
Phone:
Fax: |
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Quantity |
Code |
Price |
Description |
Amount |
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100 |
185.00 |
START Training
Module: VHS Video Tape (17 minutes);
START Reference cards (50); Sample Triage tags;
Instructor Manual - Overheads, Tests, QA Tools. |
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111 |
185.00 |
START Training
Module: DVD
(17 minutes);
START Reference cards (50); Sample Triage tags;
Instructor Manual - Overheads, Tests, QA Tools. |
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150 |
49.95 |
Extra START VHS
Video Tape (Registered Users Only) |
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171 |
49.95 |
Extra START DVD
(Registered Users Only) |
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400 |
12.50 |
Extra START Cards
- (Price for pack of 50 cards) |
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200 |
97.50 |
MVI Training
Module - VHS Video Tape (22 minutes) and
Instructor Manual |
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221 |
97.50 |
MVI Training
Module - DVD (22 minutes) and
Instructor Manual |
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Subtotal |
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California Orders only - Please Add CA
Sales/Use Tax (7.75%) |
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UPS shipping charge will be added to your
order |
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TOTAL |
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