Has church ordered previously? Select Yes No   Order Date      Date Needed

Person Ordering       Position

Church Phone   ext.    Church Fax

Day Phone  ext. Is that # Select work home ?

E-mail address 

We need Church information before processing any order.  We prefer shipping to the Church.

Church Name  

Church Delivery Address (include street, city, state & zip)

Church Billing Address if different (include street, city, state & zip)

Ship to if different than Church: Select work home (include street, city, state & zip)

Method of Payment (Check one):

         Select Church Purchase Order Bill to Church Sent Check Church Credit Card Personal Credit Card

        Please indicate in the box below:

    *If ordering by Church Purchase Order indicate Church Purchase Order Number;

    *If ordering by Check indicate Check Number;

    *If ordering by Church Credit Card indicate Type of Card, Card Number & Expiration Date;

    *If ordering by Personal Credit Card indicate Name on Card, Type of Card, Card Number, Expiration Date,

Daytime Phone of Cardholder, Street Address & Zip only.

Tax Exempt #

    1)     Choose from stock or custom bracelets:

             Select Stock Disposable Tyvek Bracelet Custom Printed Disposable Tyvek Bracelet

   2)    Color: 

               Stock  Select White Yellow Neon Orange Red Pink Purple Lime Aqua Light Blue Process Blue (Choose more than one color by holding down control and highlighting your selection)

                Custom Select White Green Glow Neon Yellow Yellow Neon Orange Orange Sunfire Red Neon Pink Pink Purple Lime Green Aqua Light Blue Process Blue Grey (Choose more than one color by holding down control and highlighting your selection)

   3)    Quantity:  (If more than one color choice is made then specify quantity for each)

   4)    Price Per Bracelet Per Color as indicated above: 

   5)    Total Price for Entire Quantity: 

   6)    Set-Up Charge (for Custom Only) Select Custom- Add $50.00 To My Order Stock- Do Not Add $50.00 To My Order

   7)    Imprint for Custom Orders:

If you are ordering two or more stock items EX: Kiddie Keepers and Stock Diaper Bag Tags add one shipping charge to the total order.  Stock shipments are totaled and shipped together from our office.

   8) If you are ordering additional items please use the spaces below:

    10)    Shipping Charges as indicated below:  

Stock SHIPPING SCHEDULE: General Shipping for items shipped from our in-stock products.

$0-25 =$7.50   $26-50 =$8.00   $51-100 =$8.50   $101-150 =$9.50   $151-200 =$10.50

Add $1 for every $50 over $200 (Some items may be more / EX. mugs, squeeze bottles, etc.)

Add approximately $10 for UPS 3 day select / $15 for UPS blue 2 day service

Please Note: If you are ordering two or more stock items EX: Kiddie Keepers and Stock Diaper Bag Tags add one shipping charge to the total order.  Stock shipments are totaled and shipped together from our office.

    11)    Total Purchase Amount:

We consider it a blessing to be a part of your ministry!!!

Jamie Cardell, Pam Reeves, Christy Godfrey, Deanna Burkhardt and Joy Carlisle