Free ORDER FORM - Arizona

ORDER FORM
STANDARDS BOOKS GENERAL INDUSTRY ----------------------- $20.00 CONSTRUCTION INDUSTRY -------------- $15.00
WE DO NOT SHIP TO P.O. BOX-WE MUST HAVE A STREET ADDRESS Payment must be money order or check. Please, no cash. NAME COMPANY NAME STREET ADDRESS CITY TELEPHONE NUMBER I wish to purchase: copies of the GENERAL INDUSTRY STANDARDS copies of the CONSTRUCTION INDUSTRY STANDARDS TOTAL PURCHASE PRICE + SHIPPING/HANDLING STATE ZIP

Make checks payable to: INDUSTRIAL COMMISSION OF ARIZONA MAIL TO: Division of Occupational Safety & Health Industrial Commission of Arizona P.O. Box 19070 Phoenix AZ 85005-9070 Phone: (602) 542-5795 Fax: (602) 542-1614 (See reverse side for shipping and handling rates) FOR OFFICIAL USE ONLY Date request received: Receiver's Name (Please Print) I.D.#

Date picked up:

Date mailed: Paid: Money Order or Check (circle one) # INITIALS

FedEx Rates
(Including shipping and handling fees) Number of books 1 2 3 4 5 6 7 8 9 10 $5.15 $6.25 $7.35 $8.45 $9.55 $10.65 $11.75 $12.85 $13.95 $15.05

(More than 10 will be an additional $1.10 per book)