order form: international addreses only TO ORDER BY PHONE: 001-708-799-2300, x33801, Mon–Fri, 8 a.m.–7 p.m. CT TO ORDER BY FAX: 001-708-799-4981 TO ORDER BY MAIL: 25442 Network Pl., Chicago, IL 60673-1254, USA TO ORDER ONLINE: shop.iccsafe.org All International Orders must be prepaid in U.S. Funds drawn on a U.S. Bank. We gladly accept payment by MasterCard, Visa, American Express, Discover, JCB or a check/money order denominated in U.S. dollars and drawn on a U.S. bank. All prices are quoted in U.S. dollars. Date ______ /______ /______ Ship To: (Please Print) Person ordering ________________________________________________________________________________________________________________________ Company or Jurisdiction ___________________________________________________________________________________________________________________________________________________ Attn: ______________________________________________________________________________________________________________________________________________________ Street __________________________________________________________________________________________________________________________________________________________________________________ City _________________________________________________________________________________________________________________________________________________________________________________ State/Province_________________________________________________________ Postal Code ___________________________________________________________________________________ Country ________________________________________ Daytime Phone_________________________________________________________________________________________________________ E-mail______________________________________________________________________________________________________________________________________________________________________________ List Price, Member Price, Item Number Qty Each Each Description (specify edition) Total Method of Payment: (Nonmembers of ICC must prepay by credit card, check or money order.) q Check or money order q Bill my Membership No. q Purchase Order No.: (COPY OF AUTHORIZED P.O. REQUIRED) q MasterCard q VISA q Discover q American Express CVV# (3- or 4-digit security code printed on card) Card No. ______________ /______________ /______________ /______________ Expires__________ /___________ Name as it appears on card: Signature (required) ICC USE ONLY CHECK BOX IF YOU WOULD LIKE ADDITIONAL INFORMATION q Membership Application q Certification information q Product Catalog q Seminar information International Shipping Standard: Canada and Mexico............20% of subtotal All Other Countries...$25+20% of subtotal Call for Express Delivery Billed: q FedEx Acct. #________________________________________ Deliveries to remote areas may be delayed. All payments in U.S. Funds. *Wire Transfers Add $25 (U.S.) for bank fees. Wire to: JP Morgan Chase Bank, N.A. ABA 0210-00021 Acct. #935163733 SWIFT Code: CHASUS33 Date funds sent: _________ /_________ /_________ Please send email notification of transfer to: collections@iccsafe.org Thank you for your order! ICC Members: Provide your member number to receive discount pricing _________________________________________________________________________ Subtotal Shipping 15-10950 07/15 PRICES SUBJECT TO CHANGE.
2015_Product_Catalog
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