Order products from the American Society of Phlebotomy Technicians

American Society of Phlebotomy Technicians Order Form
Last Name: _______________________________________________ First Name: _______________________________________________ Physical Address: _______________________________________________ (no PO Boxes please) City, State and Zip Coce: _______________________________________________ Day Phone # (____) ______ - ____________
Quantity	Size	Total
Pins: $14.00 __________________ ____________________ ____________________ Certified Rockers (Phlebotomy, EKG): $10.00 __________________ ____________________ _________________ **Shipping and Handling of $7.50 per item shipped in the continental US. Outside of the continental US shipped freight collect. No purchase orders accepted. Add Shipping & Handling (see above) ____________________ Total Enclosed (check or money order) _______________________
Type of Payment: Check # _________ MO # ______________________ Cash only at an event Amount enclosed $ ___________________ Please send order form and payment to:
ASPT P.O. Box 1831 Hickory, NC 28603 Phone: (828) 294-0078 (message line) Fax: (828) 327-2969