Ad Program I.D. Kits
Application
Name of Business/Profession
Address
City
State
Zip
Type of Category
Date
Phone
Fax
Email
Name of Person Ordering
Payment
Check Fax check made payable to: NATIONAL CHILD I.D. KITS, 516-327-0805
Credit Card
Card Number:
Exp. Date:
Card Type:
Amex
MC
Visa
Discover
Check one size and cost:
$299 Single
$399 Double
$699 Quad (no tax)
(to appear on front cover add add'l $100)
TOTAL (PAID) $
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