565 Westlake St., Bldg 100,  Encinitas, CA 92024

Phone: 760.944.1048           Fax: 760-944-2959

Fax/Mail

Order Form

ORDER NUMBER (If any):

 

Customer Name:      

Ship To Address (If Different):

Credit Card Billing Address:      

     

     

     

     

     

Customer Phone/Email/Fax:      

     

     

 

 

ORDER Date

requisitioner

Ship via

f.o.b. point

terms

     

     

FedEx Ground

San Diego

Pre Pay

 

qty

SKU / ITEM#

description

unit price

total

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

CREDIT CARD PAYMENT (MC/VISA/AMEX ONLY)

SUBTOTAL

     

Daytime Tel:      

SALES TAX (California Only 7.75%)

     

Name on CC:      

SHIPPING & HANDLING (SEE CHART)

     

Expiration Date:      

OTHER

     

CC #:     

TOTAL

     

 

 

Authorized by X___________________________ Date_______            

Shipping (Based on product total)

 

Send all payments by check to:

Express Compaines, Inc. dba First Aid Product.com

565 Westlake St., Bldg 100, Encinitas, CA  92024

760.944.1048  E-MAIL: info@first-aid-product.com

$0.01 - 9.99 

$ 6.50

$10.00 - 49.99 

$ 7.75

$50.00 - 99.99 

$10.75

$100.00 - 199.99 

$15.75

$200.00 - 399.00 

$ 26.50

$400.00 - 699.00 

$36.50

$700.00 - 1000.00

$46.50

$1000.00 - $1800.00

$56.50

$1801.00 +

CALL FOR SHIPPING