EMC ORDER and RENTAL FORM
Name_________________________ Phone__________________ Date ___________________________
Company, Purchase order numbers and Tax-exempt number if applicable ___________________________
Pick up ____ or Mail (additional fee for shipping)____If mailing is requested please enclose address to mail to.
Make check payable to EMC
Mail to EMC 190 US Route 1 #371, Falmouth, ME 04105
Book and DVD for purchase
Books
CPR for Friends and Family available in pk of 5
Friends and Family first aid 5 per pk
Heartsaver CPR and AED textbook
Heartsaver first aid
Heartsaver first aid with CPR and AED
Heartsaver Pediatric First Aid student handbook not new
BLS textbook
BLS instructor Manual
Core Instructor manual
BLS Instructor packet (instructor manual, student manual, DVD,
stopwatch and posters save money)
Heartsaver Instructor manual (all inclusive)
Epi Pen Trainer
First Aid Training Supplies (epi trainer, blanket, 25 4x4, 2 roller gauze)
First Aid fold out card (per each) new
Heartsaver first aid pediatric reference cards (per each) not new
Heartsaver adult CPR and AED wallet cards (100 per pk)
Heartsaver child and infant CPR wallet cards (100 per pk)
Price
Quantity Total Price
8.00/pk
8.00/pk
12.75
9.75
15.00
15.00
12.75
35.00
26.75
102.00
52.50
5.00
8.00
5.50
5.50
11.75
11.75
DVD
Friends and Family DVD
Friends and Family First Aid for children DVD
32.00
30.50
Heartsaver CPR and AED and First Aid DVD
160.00
BLS DVD
70.00
Heartsaver First Aid pediatric DVD not new
96.00
One way valves Box of 10
Econo pocket mask box of 10
Red pocket mask adult/child no infants
Red Case pocket mask adult/child and infant
12.75
32.00
9.00
10.00
Cards and Order Total Summary on reverse side
Card (must include
roster)
Heartsaver
BLS/HCP
Heartsaver AED
Price
Heartsaver First Aid
Pedi Heartsaver FA
2.50
2.50
Quantity
2.50
2.50
2.50
Total
Price
RENTAL
10 Pk Adult dolls
10 Pk of infants
Combo infants and
adults (10 ea)
25 pk adult dolls
DVD
AEDs per one
Philips Heartstart,
Medtronic
AED 6 pk mini
trainer
AED 12 pk mini
trainer
Rental
Cost
25.00
15.00
35.00
Total
Cost
50.00
5.00
15.00
35.00
50.00
Total Cost of order__________ +
5% Maine State Sales Tax ________= Total cost enclosed_________
(tax applies to cpr cards as well)
st
Orders must be placed by the 1 of the month.
Orders placed after the 1st will be placed with the next
months orders
If you are requesting materials be mailed (additional postage):
Name: __________________________________
Mailing Address: ____________________________________________________
City _____________________________State ___________________ Zip __________________
V 7.11