JSU Order Form 9-05

							INSTITUTE FOR EMERGENCY PREPAREDNESS                             Mail or Fax to:
JACKSONVILLE STATE UNIVERSITY                                    351 N. Williamson Blvd.
700 PELHAM ROAD NORTH                                            Daytona Beach, FL 32114-1112
JACKSONVILLE, AL 36265                                           FAX: 386-322-9766

                           APCO Virtual College Bookstore
                                    Order Form
Student Name

Daytime Phone                                        Fax

Agency Name ___________________________________________________________

Shipping Address

City                                                     State              Zip

         A METHOD OF PAYMENT MUST ACCOMPANY YOUR ORDER (US FUNDS ONLY)
  CHECK ENCLOSED #
  Purchase Order #                              COPY REQUIRED
 VISA                      MASTERCARD                      DISCOVER                                AMEX

Card #                                                               Exp. Date

Card Holders Name: __________________________ 3 or 4 Digit Security Code: _______________

Card Holders Address:




Signature:


                                                                                        Quantity      Total

 PST 110     Public Safety Telecommunicator 1 Student, 6th edition      $89.00

 PST 315     Emergency Medical Dispatch                                 $89.00




  Orders will NOT be processed with-
  out this form.                                              Sub-total

  This form should be completed and                           Shipping & Handling:
                                                              7%, 14% if received less than 21
  returned to the APCO Institute at                           days from start date; Overnight
  least 21 days prior to the class start                      shipping $22.50 for first book and
                                                              $10.00 for each additional book
  date.                                                       WA State add 8.5%
                                                              TOTAL ORDER
  Otherwise, shipping charges
  will be: 14% of the total order
                                                                       JSU Order Form                Prt 9/05