KAPOW SUPPLY ORDER FORM

ORDERED BY

 

 

PHONE/ FAX/EMAIL

Phone: (     ) ____________________

Fax:     (     ) ____________________

Email:   _______________________

DATE ORDERED

DATE NEEDED

AFFILIATE/PARTNERSHIP TO BE BILLED

 

 

 

SHIPPING ADDRESS

 

Quantity Ordered

Item

Price

Total

 

Curriculum Book

$34

 

 

Certificate of Appreciation      

$1

 

 

Student Video

$15

 

 

Orientation Video                   

$17

 

 

Student Pack (folder, bookmark)

$3.50

 

 

Program Manual

Worksite Visit Manual

$26

 

 

$22

 

 

Training Manual                      

$22

 

 

Affiliate Manual                       

$25

 

 

Paper Cube                            

$6

 

 

Mouse Pad                             

$7

 

 

Pencil

$.50

 

 

Water Bottle               

$7

 

 

T-shirt

$11

 

 

KAPOW stickers sheet

$ 2

 

Total Cost of Order        $

Orders sent standard ground UPS unless otherwise specified.