ESP Affiliate Price List Order Form PD 5

User Manual: ESP-Affiliate-Price-List-Order-form-PD-5

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AFFILIATE: Spanish
CREIGHTON MODEL FertilityCare™
LATIN AMERICA AFFILIATE PUBLICATIONS ORDER FORM (PD-5)
Name

Order Date

Phone

FCCA Center name

Fax
Email

FCCA Center #
Purchase Order #

BILL TO:

SHIP TO:

Name

Name

c/o

c/o

Address

Address

QUANTITY ITEM
Spanish Charts
Spanish User Manuals
Spanish Introductory Session
PowerPoint on CD
Spanish Spice Index Cards
Spanish Introductory Session
Evaluation
Spanish Follow-up Evaluation
Spanish Teacher Evaluation
Spanish Reproductive Category
Spec. Cycle Review
FCCA Brochure (Spanish)
Follow-up Forms (English)
Information Cards (English)
Organizer Sheets (English)
1 Stamp Starter Pack
Plain Red Stamp
White Baby Stamps
Plain Green Stamps
Green Baby Stamps
Plain Yellow Stamps
Yellow Baby Stamps

PACKAGE
Each
Package of 25
Each
Each
Package of 25

PRICE
$1.50
$32.50
$10.00
$95.00
(Non-returnable item)

$13.50

Pad of 25

$7.00

Pad of 25
Pad of 25

$7.00
$7.00

Pad of 25

$7.00

Each
Each
Pack of 25
Package of 25
Pad of 25
11 sheets + bag
Per sheet
Per sheet
Per sheet
Per sheet
Per sheet
Per sheet

TOTAL

$0.30
$3.50
$81.25
$12.00
$5.50
$2.50
$0.25
$0.25
$0.25
$0.25
$0.25
$0.25

TOTAL FOR MATERIALS ORDERED
6/1/14smt

Prices Subject to Change

IMPORTANT: Once completed, please submit order form for approval to Pope Paul VI Institute’s Publications Department
by email at publications@popepaulvi.com or by fax at (402) 390-9851. The final invoice will be mailed and/or emailed
for payment. Shipping and handling and taxes, if applicable, will be added to the invoice. Order must be pre-paid by
credit card or PayPal before shipment from the Mexico City distribution center.
CREIGHTON MODEL FertilityCare™ materials not listed on this order form must be ordered from the Pope Paul VI
Institute publications department — popepaulvi.com/shop.
Pope Paul VI Institute  6901 Mercy Rd.  Omaha, NE 68106  www.popepaulvi.com
publications@popepaulvi.com  P: (402) 505-8942  F: (402) 505-8908



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