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www.StudentSafe.com Order Form: |
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| Bill to: | Ship to: ____ check if same as Bill to: | ||||
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Name: ________________________________ |
Name: ________________________________ |
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| Organization: ___________________________ | Organization: ___________________________ | ||||
| Address: ______________________________ | Address: ______________________________ | ||||
| Address: ______________________________ | Address: ______________________________ | ||||
| City: __________________ State: _________ | City: __________________ State: _________ | ||||
| Zip: ______________ | Zip: ______________ | ||||
| Phone: __________________________ | Phone: __________________________ | ||||
| Email ID: ________________________ | Email ID: ________________________ | ||||
| Not for Profit Tax ID # ________________ | |||||
| School Safety & Educational Products: |
Quantity: |
Unit Price: |
Total: |
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| The Calorie Coach Educational Game for schools | ________ | $ 249.95 | _________ | ||
| The Drinking Can Weight Educational Game for Schools |
________ |
$ 249.95 |
________ |
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| Mock-U-Mentary Drunk Driving for Beginners - video |
________ |
$ 99.95 |
_________ |
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| Mock-U-Mentary Encourage Bullying in School - video |
________ |
$ 99.95 |
_________ |
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| StudentSafe™ Bullying Awareness video program |
________ |
$ 149.95 |
_________ |
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| StudentSafe™ School Safety video program | ________ |
$ 149.95 |
_________ |
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| StudenSafe™ The Peer Mediation™ video training program | ________ |
$ 99.95 |
_________ |
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| "Murder by Meth" Educational Video | _______ | 99.95 | |||
| Team Decisions - Win or Lose? Educational Game | ________ | $ 59.95 |
_________ |
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| Personal Wellness & Fitness Tracking Tool | ________ | $ 49.95 | _________ | ||
| The Scout Law: Quotes for Life - book | ________ | $ 10.95 | _________ | ||
| Think B-4 YOU INK: before getting a tattoo | ________ | $ 9.95 | _________ | ||
| Why Scouting: - answers about boy scouting | ________ | $ 9.95 | _________ | ||
| Life's Lessons from MOM - book | ________ | $ 10.95 | _________ | ||
| Life's Lessons from Dad - book | ________ | $ 10.95 | _________ | ||
| Dear Santa, I want... a book of emails sent to Santa | ________ | $ 9.95 | _________ | ||
| Follow the Arrow - Boy Scouting-related book | ________ | $ 10.95 | _________ | ||
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Bulk Pricing on all products |
call for pricing | _________ | |||
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Sub Total: |
_________ |
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Plus applicable taxes (Illinois residents) 7.25%): |
_________ |
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Plus applicable taxes (Iowa residents) 7%): |
_________ |
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Shipping and Handling - $4.00 per item - (maximum $10.00 per order) : |
_________ |
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Grand Total: |
_________ |
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| Visa/Master Card Credit Card #__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ Exp. Date (mm/yy) __ __ /__ __ | |||||
| Pre-Approved Purchase Order # ___________________ (Standard terms are NET 15 on a P.O. number): | |||||
| Please make checks out to Teckni-Corp, Ltd. and allow 2 weeks for standard delivery. | |||||
| Phone: 563-359-4388 Fax: 563-359-4671 | |||||
| Fax
form or mail to: Teckni-Corp, Ltd. PO BOX 866 Bettendorf, IA 52722 |
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