CBSPD Secure Merchandise
Order Form


**Printable Version of this Form**

Please Fill Out All the Information Requested in the Following Form

*NOTICE - Pin/Patch requests for individuals that are not certified through the CBSPD/NICHSPDP will not be processed. Allow 1 week for delivery when items are in stock. If an item is out of stock, you can still place your order and we will ship it when it becomes available. All costs include First Class shipping. Shipping charges may apply to large and foreign country orders. Please notify us if you want your order shipped overnight (Fedex, DHL). We will contact you with pricing options before processing your order. All prices subject to change. Any order totaling $200 or more must be sent via fedex for insurance purposes. Please call the cbspd office for a quote on shipping before placing any order totaling $200 or more.


ENTER THE QUANTITY NEEDED


All items listed are *IN STOCK*

  CBSPD Replacement Certificates@$10/ea.
Title:

  CBSPD Replacement ID Cards@$5/ea.
Title: 

  CBSPD Insulated Lunch Bags@$5/ea.
VIEW IT!
- ORDER WHILE SUPPLIES LAST!


  CBSPD Technician Pins@$10/ea.
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  CBSPD/NICHSPDP Instru. Processor Pins@$10/ea.
VIEW IT!


  CBSPD Instru. Specialist Pins@$10/ea.
VIEW IT!

  CBSPD Ambulatory Surg. Pins@$10/ea.
VIEW IT!

  CBSPD GI Scope Pins@$10/ea.
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  CBSPD Supervisor Pins@$15/ea.
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  CBSPD/NICHSPDP Manager Pins@$15/ea.
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SELECT A FORM OF PAYMENT

CREDIT CARD

Visa
Mastercard
Discover
American Express

Person's Name on Card: 

Card Number:

Expiration Date: 

Security Code on the Card: 

Credit Card Billing Address:



Comments to CBSPD Office

 



FACILITY
PURCHASE ORDERS


The CBSPD no longer accepts purchase orders of any kind. All payments must be made in advance with a credit card or bank/facility check.




 




SHIPPING INFORMATION


Name:    


Phone Number:

E-mail Address: 

Name & ID# or SS# of People Receiving Pins / Patches

Individuals MUST be CBSPD/NICHSPDP Certified

CHOOSE SHIP TO:
HOME WORK FACILITY

Department and Facility Name: 
(Skip for Home Shipping)

Address:

City: 

State: 

Zip:
 

Foreign Country: 



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