|
Infusion KNowledge, inc |
facsimile transmittal sheet
|
to: |
|
from: |
|
|
|
|
|
company: |
|
date: |
|
|
|
|
|
fax number: |
|
to send by Mail: |
|
727-442-6874 |
|
Infusion Knowledge P.O. Box 8649 Clearwater, Florida 33758 |
|
Phone number: |
|
|
|
1-800-337-1545 |
|
|
|
Re: |
|
|
|
|
|
|
Name:
________________________________________________________________
Address:
_____________________________________________________________
City:
__________________ _________ State:
___________ Zip: ______________
Employer:
____________________________________________________________
Department:
_________________________ Title: __________________________
Home
Phone (including area code):
____________________________________
Work
Phone (including area code): _____________________________________
Professional
Designation (i.e. RN, LPN, etc.): ____________________________
What products would you like to order?
____ CRNI Review Workbook: $65
____ Video:
Venipuncture Techniques for Blood Draws (Corporate Rate):
$125
____ Video:
Venipuncture Techniques for Blood Draws (Individual Rate): $65
____ Video:
Peripheral Catheter I.V. Placement (Corporate Rate): $125
____ Video:
Peripheral Catheter I.V. Placement (Individual Rate): $65
____ Video:
Implanted Venous Port Access (Corporate Rate): $125
____ Video:
Implanted Venous Port Access (Individual Rate): $65
____ Gift
Certificate: (circle one) $20 $50 $100
Total Items: __________
Subtotal: $___________ + $10 Shipping & Handling = Total: $_______________
Method of Payment:
q Check or Money Order (made payable to Infusion Knowledge)
q Visa q MasterCard q Discover
Credit Card Number: ______________________________ Expiration Date: _________
Name as it appears on Card (if different than above): ______________________________
Address that Credit Card is Billed To (if different than
above):
___________________________________________________________________________
Authorized Signature: _____________________________________________________________
Please allow 2-3 weeks for delivery.
Return Policy:
Infusion Knowledge must receive order cancellations in writing within 3 days of order placement. Order discrepancies or damaged goods must be reported to Infusion Knowledge within 1 week of receipt.
Additional Comments: