ESP Affiliate Price List Order Form PD 5

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

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Pope Paul VI Institute 6901 Mercy Rd. Omaha, NE 68106 www.popepaulvi.com
publications@popepaulvi.com P: (402) 505-8942 F: (402) 505-8908
CREIGHTON MODEL FertilityCare™
LATIN AMERICA AFFILIATE PUBLICATIONS ORDER FORM (PD-5)
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.
Name
Order Date
Phone
FCCA Center name
Fax
FCCA Center #
Email
Purchase Order #
BILL TO:
SHIP TO:
Name
Name
c/o
c/o
Address
Address
QUANTITY
PACKAGE
PRICE
TOTAL
Each
Package of 25
$1.50
$32.50
Each
$10.00
Each
$95.00
(Non-returnable item)
Package of 25
$13.50
Pad of 25
$7.00
Spanish Follow-up Evaluation
Pad of 25
$7.00
Spanish Teacher Evaluation
Pad of 25
$7.00
Spanish Reproductive Category
Spec. Cycle Review
Pad of 25
$7.00
FCCA Brochure (Spanish)
Each
$0.30
Follow-up Forms (English)
Each
Pack of 25
$3.50
$81.25
Information Cards (English)
Package of 25
$12.00
Organizer Sheets (English)
Pad of 25
$5.50
1 Stamp Starter Pack
11 sheets + bag
$2.50
Plain Red Stamp
Per sheet
$0.25
White Baby Stamps
Per sheet
$0.25
Plain Green Stamps
Per sheet
$0.25
Green Baby Stamps
Per sheet
$0.25
Plain Yellow Stamps
Per sheet
$0.25
Yellow Baby Stamps
Per sheet
$0.25
TOTAL FOR MATERIALS ORDERED
AFFILIATE: Spanish

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