PRINT Name:_________________________________________________________________________________
Firm/Org/Agency/Inst:_________________________________________________________________________
Address:_____________________________________________________________________________________
City:____________________________________ State:___________________ Zip:________________________
Telephone:
(_________) _______________________________ E-Mail:__________________________________
QUANTITY................ITEM...........................................................SUBTOTAL...................................TOTAL
Suggested Retail Price: $24.95 Per Pair. Available Now To You at $19.95 Per Pair.
_____ Single Pair(s) of Traffic Control GLO GLOVs .............@ $ 19.95 per pair $_________________
For Police, Security and Traffic Control Professionals
___12__ Pair(s) of Traffic Control GLO GLOVs .....................@ $ 18.95 per pair
$_________________
For Police, Security and Traffic Control Professionals
___24__ Pair(s) of Traffic Control GLO GLOVs ......................@$ 17.95 per pair
$_________________
For Police, Security and Traffic Control Professionals
_______ Single Pair(s) of SPORTS GLO GLOVs .....................@ $ 19.95 per pair $_________________
Bike Style - Padded Grip Palm
_______ Single Pair(s) of GENERAL PUBLIC GLO GLOVs .....@ $ 19.95 per pair $_________________
With Triangle Palm
_______ Flourescent Orange LIFE HAMMER Unit(s)..............@ $ 24.95 Each $_________________
_______ NPOAA-NPSOAA Annual Membership Fee ..............@ $35.00 Year $_________________
Email npoaa1@aol.com For Quantity Discounts on All GLO GLOV models.
Shipping via Best Way.
Subtotal of Order:$________________________
**CHECKS/MONEY ORDERS Must Be Made Payable To: NPSOAA
NJ(Only)
Purchasers Must Add 6% NJ Sales Tax: $________________ Exempt#:______________________
Total Including Sales Tax
(NJ Only):$____________________________
Total of Check/Money Order Enclosed:$___________________________
****CREDIT CARD ORDERS:
Sub-Total of Ordered Items:$_______________________________
NJ (Only) Purchasers
Must Add 6% NJS Tax $________________ Exempt#__________________________
Total Including Tax (NJ Only):$__________________________
Credit Card: ___Visa __Master Card __AMEX __Discover ....................Expiration Date:________/_______
Credit
Card Number:____________________________________________________________________________
Name on Card:_________________________________________________________________________________
Card Holder Address:___________________________________________________________________________
City:_______________________________________________ State:__________________ Zip:________________
Date of Order: _____________________ ______________, 2004
Signature:_____________________________________________________________________________________
