How to order The Safety Book For Your Family

Ordering

The Safety Book For Your Family Order Form

Print Copies For Employees, Or Send PDF Copies

Use this form to mail, fax, or telephone your order to:

John Myre
Safety Times
1265 Rogue River Ct.
Chesterfield, MO 63017

Phone: 636-536-2875
Fax: 636-536-0779

This order is for a one-time printing or mailing.
If you print or send more copies in the future, please send a new form.
The $.50 charge will apply, but not the $100 licensing fee.

You may print a copy for each employee, or send a PDF copy to your employees. You might want to add an additional amount to include potential new employees. We will send you a Word and PDF file of the book. You may make changes to the book, and use your own cover, if you wish. The one-time licensing fee is $100. The one-time royalty is $.50 per book, with a maximum total charge of $2,500.
YES, I will print or send ______ copies at $.50 per copy
Licensing fee	$100.00
Missouri customers add 7.325% sales tax
TOTAL ($2,500 maximum, excluding tax)

Name	____________________________________
Dept. or Title	____________________________________
Employer	____________________________________
Address	____________________________________
City	____________________________________
State	___________ Zip __________________
Country	____________________________________
Phone	____________________________________
E-mail	____________________________________

Method of Payment

   Credit card number ________________________ Expiration ______

       Visa, MasterCard, American Express, and Discover accepted

   Send invoice

Payment enclosed

Safety Times Company Safety Programs