Merchandise Order form

Your Premier Training Company

for the 9-1-1 Industry and Beyond

Order Form

(Please Print Form and Fax to the Number Below)

Download a PDF version here

□ Visa

□ MasterCard

□ Discover

□ American Express

Shipping Information (if different than billing address)*:

First Name: __________________________________________________________

Last Name: __________________________________________________________

Shipping Address:

_____________________________________________________________

City: _____________________________ State: _______ Zip: _________

Phone: _____________________________________________________________

Email: _____________________________________________________________

Credit Card #: ____________________________________

Expiration Date: __________________________________

CSC #

(last 3 digits on back of card - or -

small 4 digit # on front of American Express): ________

To order: print the order form, complete it and mail or fax it to us; or feel free to call or email us!

Please fax order form toll-free to 1-866-852-0072

Or Mail to:

Success Communications, Inc.

224 S. Cochran Ave.

Charlotte, MI 48813

Questions? Call 517-543-6141 or email Info@SuccessCommunicationsInc.com

Billing Information:

First Name: _________________________________________________________

Last Name: _________________________________________________________

Shipping Address:
_____________________________________________________________

_____________________________________________________________

City: _____________________________ State: _______ Zip: _________

Phone: _____________________________________________________________

Email: _____________________________________________________________

Signature: _____________________________________________________________

Product Size/Color Price

_______________________________________________ ____________

____________ Merchandise Total

____________ S & P

____________ Sub-Total

____________ 6% Tax (MI only)

____________ Total

Shipping & Processing Rates

Merchandise Total S & P

$0 through $25.00 $5.99

$25.01 through $75.00 $9.95

Over $75 FREE

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Registered for a class?

Order now and we’ll bring it to class for free! You save the Shipping & Handling fee.

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