Order Form

Pocket Edition Order Form

Warning! This website is not secure for the use of credit card sales at this time. If you would like to pay by card, please indicate below and enter the phone number where you can be reached for credit card information.

Books

Qty

Price

Extension

30 CFR Part 40-50, 100 & 104 (except Part 47) (Purple & white)		x $12
30 CFR Part 47, 56/57/58 & 62 (Blue & white) . . . . . . . . . . . . . .		x $12
30 CFR Part 46/47/48, 56/57/58 & 62 (Green & white) . . . . . . .		x $15
30 CFR Part 75 (Gray & white) . . . . . . . . . . . . . . . . . . . . . . . . . .		x $15
30 CFR Part 77 (Yellow & white). . . . . . . . . . . . . . . . . . . . . . . .		x $10
30 CFR Part 47,48, 62 & 77 (Black & white) . . . . . . . . . . . . . . .		x $12
30 CFR Part 46 & 48 (Yellow) . . . . . . . . . . . . . . . . . . . . . . . . . .		x $3
1977 Act (Pub. Law 95-164) (Brown & white) .. . . . . . . . . . . . . .		x $6

Use PO # Total books*

Subtotal

Call me for my credit card number (See table below) Disc %
Phone # (Subtotal x Disc %) Disc $
(Visa, MasterCard & Discover accepted) + 6.25 % sales tax in Utah only
(Subtotal - Disc $) Total

Mine Safety Associates

PO Box 872, Price, UT 84501

Phone: (800) 430-2377 Fax: (435) 637-8614

E-mail: sales@minesafetyassoc.com

Quantity Discounts

Books* Disc.

2-9 - - - - - 25%

10-24 - - - - 33.33%

25-49 - - - - 41.67%

50+ - - - - - 50%

Bill To:

Attention to:		Company:
Address:		City, St Zip
Ship to:
Attention to:		Company:
Address:		City, St Zip
Phone:		Fax:
E-Mail:		Ordered by:
		Date:

Instructions: Fill in the above form. Then

Hitting "Submit" will send this order by e-mail, or it can be printed and sent by fax or mail.