EMC ORDER and RENTAL FORM
Name______Phone______Date ______
Company, Purchase order numbers and Tax-exempt number if applicable ______
Pick up ____ or Mail (additional fee for shipping)____If mailing is requested please enclose address to mail to.
Make check payable to EMC Mail to EMC 190 US Route 1 #371, Falmouth, ME 04105
Book and DVD for purchase / Price / Quantity / Total Price
Books
CPR for Friends and Family available in pk of 5 / 8.00/pk
Friends and Family first aid 5 per pk / 8.00/pk
Heartsaver CPR and AED textbook / 12.75
Heartsaver first aid / 9.75
Heartsaver first aid with CPR and AED / 15.00
Heartsaver Pediatric First Aid student handbook not new / 15.00
BLS textbook / 12.75
BLS instructor Manual / 35.00
Core Instructor manual / 26.75
BLS Instructor packet (instructor manual, student manual, DVD, stopwatch and posters save money) / 102.00
Heartsaver Instructor manual (all inclusive) / 52.50
Epi Pen Trainer / 5.00
First Aid Training Supplies (epi trainer, blanket, 25 4x4, 2 roller gauze) / 8.00
First Aid fold out card (per each) new / 5.50
Heartsaver first aid pediatric reference cards (per each) not new / 5.50
Heartsaver adult CPR and AED wallet cards (100 per pk) / 11.75
Heartsaver child and infant CPR wallet cards (100 per pk) / 11.75
DVD
Friends and Family DVD / 32.00
Friends and Family First Aid for children DVD / 30.50
Heartsaver CPR and AED and First Aid DVD / 160.00
BLS DVD / 70.00
Heartsaver First Aid pediatric DVD not new / 96.00
One way valves Box of 10 / 12.75
Econo pocket mask box of 10 / 32.00
Red pocket mask adult/child no infants / 9.00
Red Case pocket mask adult/child and infant / 10.00
Cards and Order Total Summary on reverse side
Card (must include roster) / Price / Quantity / Total Price / RENTAL / Rental Cost / Total Cost
Heartsaver / 2.50 / 10 Pk Adult dolls / 25.00
BLS/HCP / 2.50 / 10 Pk of infants / 15.00
Heartsaver AED / 2.50 / Combo infants and adults (10 ea) / 35.00
Heartsaver First Aid / 2.50 / 25 pk adult dolls / 50.00
Pedi Heartsaver FA / 2.50 / DVD / 5.00
AEDs per one
Philips Heartstart, Medtronic / 15.00
AED 6 pk mini trainer / 35.00
AED 12 pk mini trainer / 50.00
Total Cost of order______+ / 5% Maine State Sales Tax ______=
(tax applies to cpr cards as well) / Total cost enclosed______
Orders must be placed by the 1st of the month. Orders placed after the 1st will be placed with the next months orders
If you are requesting materials be mailed (additional postage):
Name: ______
Mailing Address: ______
City ______State ______Zip ______

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