Call 715-395-0404
Order Form
FAX 715-395-0404
Fill in the blanks, print, e-mail or Fax the form to us:
Company:
Contact:
Phone#
FAX #
Shipping Address: (No P.O. Boxes)
City:
State:
Zip:
Video Tape Kit Number and Title -- Quantity -- Extended Price (Quantity X $125.00 +$9.50 Shipping and Handling
K20 Fatigue
K22 Winter Safety
K29 The Price of Speed
K30 Too Fast for Conditions
DWA - Driving Without Awarness
1------------------ $ 134.25
2 ----------------- $ 259.50
3 ----------------- $ 384.50
4 ----------------- $ 509.50
Call for shipping and handling rates for orders outside the continental U.S.
Total Enclosed U.S. $
MC
VISA
AMEX
Account No.
Expiration Date:
Issuing Bank (MC or VISA)
Name on Card
Signature:
After submitting the form via e-mail, use the Back button on your browser to return to the
Safety Kits List
.
Please print this form and FAX or mail to:
The Institute of Driver Behavior
1507 Tower Avenue Suite 209
Superior WI 54880
Phone/Fax 715.395.0404
email
biglite@kbjrmail.com
Call 715-395-0404 if you have any questions. You may FAX
715-395-0404