USE ONE FORM FOR EACH PRODUCT
If more than one product is purchased, payment should be calculated on only one form. ORDER ONLINE: [Link] ORDER BY FAX: fax form to 0866 485 329 ORDER BY PHONE: call 0861 111 205 ORDER BY MAIL: post to PO BOX 1074, Sea Point, 8060, South Africa
CUSTOMER INFORMATION
DATE: Day / Month / Year NAME ADDRESS CITY / COUNTY POST CODE PHONE NUMBERS Work / Cell Email address
SHIP TO: If different from customer information
NAME ADDRESS CITY / COUNTY POST CODE PHONE NUMBERS Work / cell Email address
CHOOSE YOUR PRODUCT AND CALCULATE COST Choose your product and place an X in the item column, then circle the colour and size you require (where appropriate). Fill in the price in the right hand column. Choose relevant postage and fill in the right hand column. Total up the right hand column to confirm the total cost. VAT is inclusive. Please note that all products take up to two weeks to be made up. PRODUCT SPORTS ID WRIST ICE WRIST ICE band alone Small (kids 3- 8) Red Royal Blue Medium (23cm) Neon yellow Large (27cm) Black R179 R189 R189 R210 R159 R79 R149 R40 QTY PRICE R179 R99 TOTAL
Extra Large WRIST ICE (black, red, neon-yellow) ANKLE ICE (black only) DOG ICE with chain DOG ICE with chain with medical logo DOG ICE with key ring clip TAG ALONE EPIC ICE UNI SIZE IN BLACK LIVESTRONG BAND ADULT OR YOUTH KIDS ID KIDS ICE purple & hearts Small (kids 3 8) KIDS ICE black & camo Large (27cm)
R179 R145
Medium (23cm)
ELECTRONIC ID FOR KIDS PINK or GREEN
MEDICAL ID EVERYDAY WRIST ICE EVERYDAY WRIST ICE band alone Medium Black Large (27cm) Black R120 R270 R240 R120 R120 R140 R140 R100 R100 R200 R120 R120 R179 R99
PILL ICE, PLEASE SPECIFY COLOUR CHOICE MEDI ICE BRACELET MEDI LEATHER STRAP WITH PLAQUE MEDI KIDS STRAP FISH MEDI KIDS STRAP SUN MEDI FAUX LEATHER STRAP RED MEDI FAUX LEATHER STRAP BLACK MEDI PLAQUE ALLERGIES MEDI PLAQUE SEE OTHER SIDE MEDI LEATHER BRACELET BLACK ADULT MEDI FINGER PLAQUE MEDI FLOWER PLAQUE
TOTAL (BEFORE POSTAGE) DISCOUNT CODE: LESS DISCOUNT: R25 R55
Postage Priority to post office counter (4-10 days) Postage Overnight to post office counter (delivery time, not time to
make up product)
TOTAL COST INCLUDING POSTAGE
PERSONALIZE YOUR ICE ID Print clearly, one character per space, write in capital letters. Please refer to the following to determine the number of characters per line you have and the number of lines that will fit onto the tag / bracelet.
PRODUCT
WRIST ICE / KIDS ICE / EPIC ICE EVERYDAY WRIST ICE DOG TAG / DOG ICE MEDI ICE BRACELET MEDI FINGER PLAQUE MEDI LEATHER STRAP WITH PLAQUE MEDI FLOWER PLAQUE MEDI PLAQUE ALLERGIES MEDI PLAQUE SEE OTHER SIDE
CHARACTERS PER LINE
21 21 22 20 15 15 10 18 18
NUMBER LINES
6 6 6 4 2 2 2 6 6
Any commas, or spaces between words are treated as a space. You do not need to use all six lines. We st encourage you to use the 1 three lines to state your name, city and a contact phone number. If you have any allergies or medical conditions these should be included next. See examples below. Line 1: Line 2: Line 3: Line 4: Line 5: Line 6: Sample tags
JOHN SMITH SANDTON, SA HOME 011-883-5555 MOM 082-444-4444 CELL DISCOVERY 12345678 SARAH ANGEL DURBAN, SA HOME 013-555-5555 MOM & DAD 013-555-5555 ALLERGIC PENICILLIN SAFER WITH ICE
ROBERT DU TOIT BLOEMFONTEIN, SA 013-555-1212 / 554-1212 BLOOD TYPE B POS INSULIN DIABETIC
PAYMENT INFORMATION mark payment choice with an X
Attach Cheque to this form payable to ICE ID (mail orders only). Pay by Electronic Transfer : FNB Acc No. 62130329172, Branch: Sea Point 201-809 Use name as reference. Email payment confirmation to orders@[Link], fax or email with form. Pay by Credit Card: Provide all information below. Only Visa and Mastercard accepted. Place a cross in the Visa or Master Card box. Visa Cardholder Name Credit Card No. CVC No. Signature Find the Card Verification Code (CVC) number on the back of the card Mastercard Card Expiry Date: (mm/yy)