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					                                                                       Laminated picture card communication systems
                                                                          made to order to meet individual needs

                                                               PictureCard Communication Order Form
                                                                        “Keys” & Keychains

                Dollar amounts quoted are in Canadian Dollars; taxes (PST = 8%), shipping and handling charges are extra (see below).
Individual keys are available in three formats:                                The cost of “Keys” is as follows:
       Keychain Keys                                                                 Keychain Keys    – 6 for $10.00
       Velcro Keys for use with a VelcroBoard                                        Velcro Keys      – 9 for $15.00, plus $10.00 for Velcro Board
       Magnetic Keys for use on magnetic surfaces,                                   Magnetic Keys    – 9 for $15.00
        such as a refrigerator
Shipping & Handling Charges:                                                   Payment Methods in Canadian Dollars:
       Within Canada                    ─ $5.00                                      Certified cheque
       To the United States             ─ $8.00                                      Money order (postal money order or bank draft)
       International                    ─ $10.00
                                            Please select (check) all of the Keys you would like to purchase below:
                                                                                                                                  
          K1 – Are you thirsty?                 K2 – I am thirsty                          K3 – Water                                       K4 – Coffee
          K5 – Tea                              K6 – Apple juice                           K7 – Orange juice                                K8 – Tomato juice
          K9 – I am hungry                      K10 – Breakfast time                       K11 – Lunch time                                 K12 – Dinner time
          K13 – I feel hot (adult)              K14 – I feel cold (adult)                  K15 – I am happy (adult)                         K16 – I am sad (adult)
          K17 – I am mad (adult)                K18 – I am surprised (adult)               K19 – Not yet available                          K20 – Not yet available
          K21 – Not yet available               K22 – Not yet available                    K23 – Not yet available                          K24 – Not yet available
          K25 – Play bingo (adult)              K26 – Play cards (adult)                   K27 – Church (adult)                             K28 – Music (adult)
          K29 – Phone family (adult)            K30 – Read (adult)                         K31 – Sit outside (adult)                        K32 – Time for therapy
                                                K34 – I want
          K33 – Watch TV (adult)                                                           K35 – Computer time (child)                      K36 – Listen to music (child)
                                                (can be personalized)
          K37 – Watch TV (child)                K38 – Go to the park (child)               K39 – Play time (child)                          K40 – Craft time (child)
          K41 – Bathroom                        K42 – Ride trike (child)                   K43 – Cane                                       K44 – Crutches
          K45 – Pull-up (1)                     K46 – Pull-up (2)                          K47 – Walker                                     K48 – Wheelchair
          K49 – Bathroom                        K50 – Wash                                 K51 – See a doctor (M)                           K52 – See a doctor (F)
          K53 – Doctor is here (F)              K54 – Doctor is here (M)                   K55 – Medication time                            K56 – Need medication
          K57 – Toothache                       K58 – See a dentist                        K59 – Not yet available                          K60 – Not yet available
          K61 – Headache (F)                    K62 – Headache (M)                         K63 – Stomachache (F)                            K64 – Stomachache (M)
          K65 – Brush teeth                     K66 – Clean dentures                       K67 – Brush hair                                 K68 – Wash hair (F)
          K69 – Wash hair (M)                   K70 –                                      K71 –                                            K72 –




                     Email ♥ info@picturecardcommunication.com ♥ Web Site ♥ www.picturecardcommunication.com
                                                            Laminated picture card communication systems
                                                               made to order to meet individual needs

                                                      PictureCard Communication Order Form
                                                               “Keys” & Keychains


                                                                                            Number of Keys selected:
 # to be
                              Description                                                Cost                                       Subtotal
Purchased
            Keychain Keys                                                           @ 6 for $10.00                      $
            Magnetic Keys                                                           @ 9 for $15.00                      $
            Velcro Keys                                                             @ 9 for $15.00                      $
            Velcro Board                                                               @ $10.00                         $
            Keychain                                                                   @ $2.00                          $
                                                                                                               Subtotal $
                                                                                          PST (8% payable in Canada) $
                                                                          Shipping & Handling (within Canada) ─ $5.00 $
                                                                    Shipping & Handling (to the United States) ─ $8.00 $
                                                                          Shipping & Handling (International) ─ $10.00 $
                                                                                                             Total Cost $
                             Please indicate your method of payment (in Canadian Dollars) below:
                 Certified Cheque           Yes            No               Money order           Yes         No

Note:   If personalization of some keys is required, additional charges will apply and a quote will be provided.            Personalization Required:
        Send your images to info@picturecardcommunication.com in GIF or JPEG format.
        Please identify (K1, etc.) which keys you would like personalized.                                              Yes              No


                                      Please provide your mailing address and contact information below.
                       First Name:                                                                      Last Name:

   Company Name (if applicable):

              Street Address (1):                                                             Street Address (2):

              Street Address (3):                                                                            City:

                  Province/State:                                                                 Postal/Zip Code

                           Country:                                                                  Telephone No:

                   Email address:

                   Date of Order: Friday, March 18, 2011




                                                                 Instructions:
Please complete this form, save it electronically and email the completed form to info@picturecardcommunication.com.
In addition, please print two copies of this form; keep one for your records; send the second copy with your certified
cheque or money order made payable to “PictureCard Communication” to:

                                                    PictureCard Communication
                                             9 Airycot Circle, Nepean, ON K2J 2L2 Canada

                                              We thank you for your interest in our products.



             Email ♥ info@picturecardcommunication.com ♥ Web Site ♥ www.picturecardcommunication.com

				
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