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Customer Name:
Phone: Fax:
Shipping Address:
Billing Address:
Date:        /        /2007

 
Item Number
Item Name
Quantity
Unit Price
Total
         
         
         
         
         
         
         
         
         
         

Credit Card Information (VISA / MC / AMEX / Discover, only)
Name on CC :


CC Number :


Expiration Date :

Authorized By: (signature)
SubTotal:
  
Shipping & Handling:
  
Tax:
CA residents add 7.75%
AZ add 7.95%
  
Total:
  

                 Shipping Info:              

                       Your Total is:                       Shipping Price:

$0.01 to 49.99                           $9.50 $250.00 to $699.99            $38.50
$50.00 to $99.99                       $14.50 $700.00 and UP                 $48.50
$100.00 to $249.99                    $19.50  
*Additional shipping charges will be added for heavy/ bulk items.

CPR Supplies       Suite: A110-242      7904 E. Chaparral Rd..        Scottsdale, AZ 85250
Email: info@cpr-supplies.com   -  Toll-Free: 1-800-480-1277  -  Fax: 1-760-720-6278