Name: ____________________________

Address:___________________________

Work #:______________Cell:____________

Email: ______________________________    Website:____________________________

Description     QTY      Price Each          Amount

------------------------------------------------------------

CPR  eCards       ______           ______        ______

BLS Ecards $7.15 per eCard

Heartsaver Ecards $25.15 per eCard:

CPR AED, FA, FA CPR AED, Pedi FA CPRAED 

K-12 (ONLY FOR ISD's) $5.15 per eCard

 +

x Tax (8.25%)                                         ______

 +

Processing & Handling :                        ______
(apply to all orders)                   

 $0-$100.00 = $9.95

$100.01- $250.00 = $13.95

$250.01 - $400.00 = $16.95

$400.01 and Up = $18.95

                                                                                                      

                                                                 

                                          = Total    $______

Payment Info:

______ ______ ______ ______     ____/____
Debit/Credit Card Number              Exp. Date 

________       _____________
CVV                 Zip Code