2014 Order Form
T-SHIRT ORDER FORM
NATIONAL WORK ZONE AWARENESS WEEK April 7-11, 2014 - Seattle, Washington
1
FOUR EASY WAYS TO ORDER:
By Phone: 877-642-4637 █ By Fax: 540-368-1722
Online: Download Form at www.atssa.com/events █ Mail Order Form to ATSSA
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2
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SPECIFICATIONS - Please Fill Out Size, Quantity and Color Requirements: SIZE S M L XL XXL 3XL 4XL
UNIT PRICE $13.50 $13.50 $13.50 $14.00 $15.00 $15.25 $15.50
QUANTITY
Orders MUST be prepaid by March 7, 2014 T-shirts will be mailed by March 31, 2014
TOTAL
Safety Orange
SUBTOTAL TAX + SHIPPING
Safety Green
* Work Zone Pins & Ribbons are available for purchase. Pins: $10.00 - Ribbons: $1.00
ORDER TOTAL
GROUND SHIPPING TABLE: # of T-Shirts: Freight:
1-4 $6.50
5-8 $7.50
9-12 $8.00
13-16 $8.50
17-20 $9.50
21-30 $12.50
31-40 $15.50
41-50 $18.50
51-75 $26.50
76-100 $31.50
Please Include $10.00 for each additional 25 shirts ordered.
SHIPPING POLICY: Orders will be shipped via UPS Ground Service unless otherwise requested (additional charge for special shipping services). Additional shipping will be charged for all shipments outside the contiguous 48 states, please call for quote.
3
PERSONAL INFORMATION: Name: ___________________________________________________ Title: ___________________________________________ Email:____________________________________________________________________________________________________ Company/Agency: _________________________________________________________________________________________ Shipping Address: __________________________________________________________________________________________ City: _______________________________________________ State: __________________________ Zip: _________________ Phone: (________)______________________________________ Fax: _______________________________________________ Please indicate where you heard about this year’s t-shirts: _____E-mail
4
_____Signal
_____Flash
_____Chapter Meeting
_____Other
PAYMENT INFORMATION: Check Enclosed [Please make checks payable to ATSSA]
Government Purchase Order #
Credit Card - ATSSA accepts VISA, MC, AMEX
Allowed for orders over $50. A copy of a signed PO must be provided. Public agencies only.
Type of Card: _____________________________________ Name on Card: ___________________________________________ Card Number: _____________________________________________ Exp. Date: _________________________ CVV: ________ Signature: ________________________________________________________________________________________________ AMERICAN TRAFFIC SAFETY SERVICES ASSOCIATION
15 Riverside Parkway, Suite 100, Fredericksburg, VA 22406-1022
1-877-642-4637
www.atssa.com
NWZAW WEB
NATIONAL WORK ZONE AWARENESS WEEK April 7-11, 2014 - Seattle, Washington
1
FOUR EASY WAYS TO ORDER:
By Phone: 877-642-4637 █ By Fax: 540-368-1722
Online: Download Form at www.atssa.com/events █ Mail Order Form to ATSSA
█
2
█
SPECIFICATIONS - Please Fill Out Size, Quantity and Color Requirements: SIZE S M L XL XXL 3XL 4XL
UNIT PRICE $13.50 $13.50 $13.50 $14.00 $15.00 $15.25 $15.50
QUANTITY
Orders MUST be prepaid by March 7, 2014 T-shirts will be mailed by March 31, 2014
TOTAL
Safety Orange
SUBTOTAL TAX + SHIPPING
Safety Green
* Work Zone Pins & Ribbons are available for purchase. Pins: $10.00 - Ribbons: $1.00
ORDER TOTAL
GROUND SHIPPING TABLE: # of T-Shirts: Freight:
1-4 $6.50
5-8 $7.50
9-12 $8.00
13-16 $8.50
17-20 $9.50
21-30 $12.50
31-40 $15.50
41-50 $18.50
51-75 $26.50
76-100 $31.50
Please Include $10.00 for each additional 25 shirts ordered.
SHIPPING POLICY: Orders will be shipped via UPS Ground Service unless otherwise requested (additional charge for special shipping services). Additional shipping will be charged for all shipments outside the contiguous 48 states, please call for quote.
3
PERSONAL INFORMATION: Name: ___________________________________________________ Title: ___________________________________________ Email:____________________________________________________________________________________________________ Company/Agency: _________________________________________________________________________________________ Shipping Address: __________________________________________________________________________________________ City: _______________________________________________ State: __________________________ Zip: _________________ Phone: (________)______________________________________ Fax: _______________________________________________ Please indicate where you heard about this year’s t-shirts: _____E-mail
4
_____Signal
_____Flash
_____Chapter Meeting
_____Other
PAYMENT INFORMATION: Check Enclosed [Please make checks payable to ATSSA]
Government Purchase Order #
Credit Card - ATSSA accepts VISA, MC, AMEX
Allowed for orders over $50. A copy of a signed PO must be provided. Public agencies only.
Type of Card: _____________________________________ Name on Card: ___________________________________________ Card Number: _____________________________________________ Exp. Date: _________________________ CVV: ________ Signature: ________________________________________________________________________________________________ AMERICAN TRAFFIC SAFETY SERVICES ASSOCIATION
15 Riverside Parkway, Suite 100, Fredericksburg, VA 22406-1022
1-877-642-4637
www.atssa.com
NWZAW WEB
