Order Form

ITEM QTY PRICE EACH TOTAL
Limb Loss Resource Guide
Individual copies
$8.50
Limb Loss Resource Guide
Box of 25 ($7.50 each)
$187.50
Customization Fee *
Minimum order of 100 required.
$8.00
+ Shipping and Handling **

S&H applied to cost of copies only.     

TOTAL

* Customization fee includes your company's full-color logo and contact information on bottom back cover.
Please allow 710 additional business days for processing. One digital PDF proof provided.

** Additional charges apply when shipping outside the continental USA. If you are shipping outside of the continental USA, please submit this form and we will contact you to arrange payment.

** Continental USA Shipping Charges:

1-2 Copies: $5.75

3-4 Copies: $11.50

5-18 Copies: $12.35

19 or more copies: 10% of total

Single copies will be mailed via USPS within the continental USA. Bulk orders will be mailed via FedEx or UPS Ground Service within the continental USA. Please allow 23 weeks for delivery. International orders will incur additional shipping and handling charges.

Ordering more than 15 boxes? Call 303.255.0843 or e-mail for discounted pricing.

Ship To:

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City*
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Phone
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Bill To:

Credit Card Type*
Credit Card Number*
Name on Credit Card*
Expiration Date*
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Additional charges apply when shipping outside the continental USA. If you are shipping outside of the continental USA please submit this form and we will contact you to arrange payment.

Additional Limb Loss Resources:

Day of Birth*
(To validate your subscription for audit purposes.)
I am a(n) (please check all that apply)*

Note: With a qualifying subscription, subscribers will receive advance notice of new print and electronic resources, some of which will be mailed free of charge within the continental USA. International subscribers will incur mailing charges.

Amplitude Media Group | 11154 Huron Street, Suite 104 | Northglenn, CO 80234 | Phone: 303.255.0843 | Fax: 303.255.0844 | info@amplitude-media.com

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