ATSSA Products Order Form
ATSSA Products Order Form Order products using this form, visiting the Online Store, or calling ATSSA Customer Service. ATSSA Products Order Form Product Code
*Shipping Charges
Product Description
Qty
Price Each
Total
3-Day
2-Day
Next Day
$ 0.00
$1 - 9.99
$6.00
$9.50
$12.00
$28.00
$ 0.00
$10 - 24.99
$7.50
$12.00
$15.50
$33.00
$25 - 49.99
$8.50
$15.00
$19.00
$39.00
$ 0.00
$50 - 74.99
$10.50
$17.00
$23.00
$44.50
$ 0.00
$75 - 99.99
$11.50
$21.00
$29.00
$53.00
$100 - 199
$15.50
$27.00
$37.00
$65.00
$200 - 299
$17.50
$34.00
$50.00
$78.00
$300 - 399
$21.50
$42.00
$62.00
$90.00
$ 0.00
$400 - 499
$26.00
$50.00
$74.00
$104.00
$ 0.00
$500 - 599
$29.50
$58.50
$85.50
$120.00
$600 - 699
$33.50
$67.50
$96.50
$133.00
$ 0.00
$700 - 799
$36.00
$75.00
$107.50
$150.00
$ 0.00
$800 - 899
$39.00
$83.00
$118.00
$167.00
$900 - 999
$42.50
$92.00
$131.00
$188.00
$ 0.00
*TAX: We are required to collect sales tax on all products.
SUBTOTAL
California requires a district tax in addition to the state tax.
TAX & SHIPPING* ORDER TOTAL
$ 0.00
Methods to Order
SUBTOTAL
Ground
Shipping Policy ■ Cannot be shipped to a PO Box. ■ Orders are shipped UPS Ground unless otherwise requested.
Call: 800-272-8772 Fax: 540-368-1717 Email: [email protected] Online: atssa.com/OnlineStore Mail: ATSSA Products 15 Riverside Parkway, Suite 100 Fredericksburg, VA 22406-1077
■ All UPS Ground, Next Day Air, 2nd Day Air and 3-Day shipment rates are throughout the contiguous 48 states. ■ No COD orders will be accepted at any time. ■ Same Day “Rush” orders will incur a $20 surcharge. ■ Orders processed using your shipping account incur a $10 surcharge. ■ For orders totaling $999.00 or more, you must call for a freight quote.
GENERAL INFORMATION: Name: ________________________________________________________________________________________________________ Company/Agency: _______________________________________________________________________________________________ Mailing Address: ________________________________________________________________________________________________ City:______________________________________________________ State: ________________________ ZIP Code: _____________ Shipping Address: _______________________________________________________________________________________________ City:______________________________________________________ State: ________________________ ZIP Code: _____________ Phone: _____________________ Fax: ____________________ Email: ____________________________________________________
PAYMENT:
□
Check Enclosed - Payable to American Traffic Safety Services Association (ATSSA)
Please Charge My:
□ VISA
□ MASTERCARD
□ AMERICAN EXPRESS
Card Number: ____________________________________________________ Exp. Date: __________________ CVV: _____________ Name of Cardholder: ______________________________________ Authorized Signature: _____________________________________ Government Purchase Order #: _____________________________________________________________________________________ (Only accepted for orders over $50 | Copy of purchase order required at time of order)
AMERICAN TRAFFIC SAFETY SERVICES ASSOCIATION Form revised 07/2016
15 Riverside Parkway, Suite 100, Fredericksburg, VA 22406-1077 • 800-272-8772 • www.atssa.com
*Shipping Charges
Product Description
Qty
Price Each
Total
3-Day
2-Day
Next Day
$ 0.00
$1 - 9.99
$6.00
$9.50
$12.00
$28.00
$ 0.00
$10 - 24.99
$7.50
$12.00
$15.50
$33.00
$25 - 49.99
$8.50
$15.00
$19.00
$39.00
$ 0.00
$50 - 74.99
$10.50
$17.00
$23.00
$44.50
$ 0.00
$75 - 99.99
$11.50
$21.00
$29.00
$53.00
$100 - 199
$15.50
$27.00
$37.00
$65.00
$200 - 299
$17.50
$34.00
$50.00
$78.00
$300 - 399
$21.50
$42.00
$62.00
$90.00
$ 0.00
$400 - 499
$26.00
$50.00
$74.00
$104.00
$ 0.00
$500 - 599
$29.50
$58.50
$85.50
$120.00
$600 - 699
$33.50
$67.50
$96.50
$133.00
$ 0.00
$700 - 799
$36.00
$75.00
$107.50
$150.00
$ 0.00
$800 - 899
$39.00
$83.00
$118.00
$167.00
$900 - 999
$42.50
$92.00
$131.00
$188.00
$ 0.00
*TAX: We are required to collect sales tax on all products.
SUBTOTAL
California requires a district tax in addition to the state tax.
TAX & SHIPPING* ORDER TOTAL
$ 0.00
Methods to Order
SUBTOTAL
Ground
Shipping Policy ■ Cannot be shipped to a PO Box. ■ Orders are shipped UPS Ground unless otherwise requested.
Call: 800-272-8772 Fax: 540-368-1717 Email: [email protected] Online: atssa.com/OnlineStore Mail: ATSSA Products 15 Riverside Parkway, Suite 100 Fredericksburg, VA 22406-1077
■ All UPS Ground, Next Day Air, 2nd Day Air and 3-Day shipment rates are throughout the contiguous 48 states. ■ No COD orders will be accepted at any time. ■ Same Day “Rush” orders will incur a $20 surcharge. ■ Orders processed using your shipping account incur a $10 surcharge. ■ For orders totaling $999.00 or more, you must call for a freight quote.
GENERAL INFORMATION: Name: ________________________________________________________________________________________________________ Company/Agency: _______________________________________________________________________________________________ Mailing Address: ________________________________________________________________________________________________ City:______________________________________________________ State: ________________________ ZIP Code: _____________ Shipping Address: _______________________________________________________________________________________________ City:______________________________________________________ State: ________________________ ZIP Code: _____________ Phone: _____________________ Fax: ____________________ Email: ____________________________________________________
PAYMENT:
□
Check Enclosed - Payable to American Traffic Safety Services Association (ATSSA)
Please Charge My:
□ VISA
□ MASTERCARD
□ AMERICAN EXPRESS
Card Number: ____________________________________________________ Exp. Date: __________________ CVV: _____________ Name of Cardholder: ______________________________________ Authorized Signature: _____________________________________ Government Purchase Order #: _____________________________________________________________________________________ (Only accepted for orders over $50 | Copy of purchase order required at time of order)
AMERICAN TRAFFIC SAFETY SERVICES ASSOCIATION Form revised 07/2016
15 Riverside Parkway, Suite 100, Fredericksburg, VA 22406-1077 • 800-272-8772 • www.atssa.com
