subject_line
E- Card Location Orders
Organization
Facility Name
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PO Number
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Date
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+
POC
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Instructor Number
*
Phone Number
email
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Shipping Address
Shipping Address
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Shipping City and State
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Shipping Zip
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**IMPORTANT CHANGE TO ORDER PROCESS ** Cards are now ordered per card and not by the pack. Minimum order QTY is 24 cards and can be composed of different card types (For example 10 BLS, 2 ACLS, 8 CPR first aid, 10 pals=32 cards total)
Provider Cards
Provider Cards are ordered by the pack
BLS for Healthcare Provider Card (Qty each card)
ACLS Provider (Qty each card)
PALS Provider (Qty each card)
Heartsaver CPR | AED (Qty each card)
Heartsaver CPR | AED | First Aid (Qty each card)
Heartsaver First Aid (Qty each card)
Heartsaver Pediatric First Aid | CPR | AED (Qty each card)
Heartsaver Cards for ( K-12 Schools Students and staff Only) (Qty each card)
Instructor Cards
Instructor Cards are ordered individually
Instructor Card
Roster submission acknowledgement
Have you loaded your previous months original rosters?
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Yes
No
Have you submitted your TCM or Online Rosters from the previous month??
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Yes
No
Select your tax status. If you are tax exempt your certificate must be on file at the center or the order will not be processed
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Exempt
Not Exempt
Enter billing address if different from shipping address.
Billing Address
Billing City and State
Billing Zip
Shipping
Shipping- Select the mailing option below
Cards are Digital no shipping cost.
Terms of Understanding
E-card locations card rates are as listed in the sites agreement and will be reflected on the Invoice emailed to the E-card location. This form is used for Ordering cards only and does not serve as a receipt. E-card locations need to review there agreement for their facilities pricing. Click below to accept and acknowledge the terms and conditions of this form and submit your order. E-card locations not with billing terms will receive an invoice for payment before order will be processed.
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I accept and acknowledge the terms of this form
CONTINUE TO SUBMIT YOUR REQUEST
Kentuckiana CPR Training Center
350 Missouri Ave Suite 101 Jeffersonville IN 47130
training@kentuckianacpr.com
812-283-1281