Step Counter Order Form for Private Individuals

For Private Individuals (non-govt)

To Place an Online order for the Step Counters:

Fill out this online form and click the Submit button.
For additional assistance, call (305) 348-1517.
ORDERS SHIPPED UPON RECEIPT OF PAYMENT. No minimum order.

CUSTOMER INFORMATION

Name

Contact Person:

Address (line 1):

Address (line 2):

City:

State:

Zipcode:

Business Phone:

Business Fax:

E-mail:

PAYMENT INFORMATION

Please make checks or money orders payable to:
Florida International University

MAIL PAYMENT TO:
National Policy & Resource Center on Nutrition & Aging
University Park, OE 200
Miami, FL 33199

ORDER INFORMATION

Quantity x $15.00 per counter	$
Shipping and handling (see rate chart below)	$
TOTAL	$

Shipping Rates

Quanitity Shipped	Packaging	Shipping & Handling
1-9	small priority carton	$5.95
10-15 units	large priority carton	$12.95
16-39	12x9x3" 2 pc carton	$15.95
40-49	12x9x3" 2 pc carton	$18.95
50-59	12x9x3" 2 pc carton	$22.95
60-69	12x9x3" 2 pc carton	$25.99
70-79	12x9x3" 2 pc carton	$28.95
80-89	12x9x3" 2 pc carton	$31.95
90-99	12x9x3" 2 pc carton(s)	$36.95
100-199	21x12x2" 2 pc carton and/or 12x9x3" 2 pc carton(s)	$41.95
200-299	21x12x2" 2 pc carton and/or 12x9x3" 2 pc carton(s)	$49.95
300-399	21x12x2" 2 pc carton and/or 12x9x3" 2 pc carton(s)	$55.95
400-499	21x12x2" 2 pc carton and/or 12x9x3" 2 pc carton(s)	$61.96

If ordering above 500, different shipping rates will apply. Please contact the Center re these orders.