order form
Foundation for Cross-Connection Control
and Hydraulic Research
a Division of the University of Southern California
BILLING INFORMATION
SHIPPING INFORMATION
Name:
Name:
Company:
Company:
Address:
Address:
City, State, Zip:
City, State, Zip:
Phone:
QTY
Email:
PROD#
MANUAL10
LFTP
DESCRIPTION
NON-MEMBER
10th Edition Manual of Cross-Connection Control
$110.00
MEMBER
$10.00
$8.00
Field Testing Backflow Preventers, 10th Edition version DVD Video
$50.00
$40.00
DVD
Working Together for Safe Water DVD Video
$35.00
$25.00
PPT
Essentials PowerPoint Presentation
$35.00
$25.00
2016 USC List of Approved Assemblies
$40.00
$25.00
LIST16
EXTENDED
$80.00
Abbreviated Field Test Procedures (ONLY w/10th Edition)
FTBP10
Shipping Fees Not Applicable
for Training Courses or Membership
Phone:
INF500
Working Together for Safe Water, set of 500 Informational Brochures
$145.00
$115.00
INF1000
Working Together for Safe Water, set of 1000 Informational Brochures
$240.00
$190.00
INF2500
Working Together for Safe Water, set of 2500 Informational Brochures
$475.00
$375.00
HINF500
Cross-Connections in Household Plumbing set of 500 Info Brochures
$145.00
$115.00
HINF1000
Cross-Connections in Household Plumbing set of 1000 Info Brochures
$240.00
$190.00
HINF2500
Cross-Connections in Household Plumbing set of 2500 Info Brochures
$475.00
$375.00
Tester Course (Fill in PROD# for specific course)
$1,250.00
$900.00
Specialist Course (Fill in PROD# for specific course)
$1,250.00
$900.00
Seminar or Webinar (Fill in PROD# for specific seminar) 6-Hour Seminar
$100.00
$65.00
Seminar or Webinar (ONLY FOR JUNE 7 or 9 DATES) 3-Hour Seminar
$100.00
$35.00
Membership Fees (calculated below)
TAX: California residents only. Membership, courses and shipping charges are not taxable.
MEMBERSHIP - ANNUAL FEES
SUBTOTAL
Associate Membership
Purveyor Membership (Those deriving income for the sale of water)
SHIPPING
Company
☐ $120.00
Up to 2,400 service connections
☐ $120.00
SALES TAX
County
☐ $500.00
State or Federal Agency
☐ $500.00
More than 20,000 service connections
☐ $1000.00
More than 2,400 service connections, but less than 20,000 ($0.05 per connection)
0
0
Number of service connections __________ X .05 = __________
☐ $ ___________
S0316
Specialist Course 21-25 Mar. ‘16*
Se0616
One Day Seminar 7 June ‘16*
Se0416
One Day Seminar 21 April ‘16*
We0616
One Day Webinar 7 June ‘16*
We0416
One Day Webinar 21 April ‘16*
T0716
Tester Course 11-15 July ‘16*
Tester Course 9-13 May ‘16*
S0716
Specialist Course 25-29 July. ‘16*
FedEx
Shipping Fees
T0516
(US Dollars Only)
$ 0.00
*Use this space for student names for courses.
PAYMENT INFORMATION (Do Not Email Credit Card Information)
Subtotal
Ground
3Day
2Day
Overnight
$0.01-$50.00
$7.50
$8.50
$10.00
$22.50
$50.01-110.00
$9.00
$31.00
$38.00
$57.50
110.01-$250.00
$13.50
$31.00
$38.00
$57.50
Expires: ____________ / ____________ CVN: ____________
$250.01-$500.00
$24.50
$55.00
$67.00
$86.50
Name on Card: __________________________________________________
$500.01-$1000.00
$35.50
$103.00
$127.00
$169.50
$1000.01-$2000.00
$43.50
$126.00
$156.00
$210.50
$2000.01-$25000.00
$55.50
$150.00
$200.00
$250.50
PHONE: 866 545 6340
Federal ID: 95-1642394
04/14/2016
TOTAL
$ 0.00
☐ Visa ☐ Mastercard ☐ Discover ☐ AMEX
Card Number: ____________-____________-____________-____________
Signature: ______________________________________________________
NOTE: All Manual Sales are FINAL; No Returns Accepted. Training Courses Cancellation
Policy: 50% refund if canceled within four weeks of the course. Payment not refundable within one week of course.
Foundation for Cross-Connection Control and Hydraulic Research
University of Southern California
Research
Annex 219
contact
information
Los Angeles, CA 90089-7700
w e b : f c c c h r. u s c . e d u • e m a i l : f c c c h r@ u s c . e d u